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1 UTILIZATION REVIEW SPECIALIST Job in Beach, FL

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SPOTLIGHT BILLING
Beach, FL | Full Time
$61k-85k (estimate)
4 Months Ago
UTILIZATION REVIEW SPECIALIST
$61k-85k (estimate)
Full Time 4 Months Ago
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SPOTLIGHT BILLING is Hiring an UTILIZATION REVIEW SPECIALIST Near Beach, FL

THE PERKS

  • FOOSBALL TABLE
  • JUICE BAR
  • AIR HOCKEY
  • IN-OFFICE MASSAGES

We also offer a team discount program for electronics, cell phones, dining, travel expenses and more. We have a work hard, play hard mentality and believe that the office should be a fun place to spend time.

THE WORK ENVIRONMENT

In order to maintain a healthy, vital work environment, it is essential for our team to be able to provide us with lots of feedback, whether it be how to improve our processes or which pinball machine we should get next. We value the opinion of our team members and do our best to make their suggestions a reality. Your voice matters at Spotlight Billing.

THE BENEFITS

We know we wouldn’t be here if it wasn’t for our team, and it’s important that they know it too.

We provide an excellent compensation package which includes competitive salary, company sponsored top-notch healthcare and life insurance policy. Our team members can elect dental, vision, and supplemental insurance benefits.

UTILIZATION REVIEW SPECIALIST
Interested applicants should send their resume, cover letter to: susan unruh Director of Human Relations sunruh@spotlightbilling.com

The Utilization Review proactively monitors and assesses clinical documentation and medical records to ensure that medical necessity criteria are met for each level of care. Coordinates with the medical and clinical staff to prepare documentations to present to insurance companies for continued authorization. The focus of our UR Specialist is to manage the review and approval process allowing the clients clinical and medical staff time to a focus on providing the highest level of care for their clients.

Essential Functions:
  • Performs clinical review for medical necessity for Facility/Member/Provider using evidenced based guidelines, policies, benefits and nationally recognized clinical criteria
  • Conducts pre-certification reviews and appeals reviews
  • Peer to Peer reviews with
  • Conducts retrospective clinical review of claims for medical necessity, coding accuracy, medical policy compliance and contract compliance
  • Negotiate with insurance companies to achieve the highest level of care for patients / clients based upon ASAM and other approved criteria
  • Conduct continuous reviews of patient progress advocating for continued client care at the maximum length of care with the highest level of benefits.
Qualifications:
  • Master Level / Licensed Clinicians or RN/LPN with proven track record in Behavioral Health and Substance Abuse
  • Knowledge of ASAM / DSM V / ICD-9, 10
  • Knowledge of Electronic Medical Records and Billing systems

Job Summary

JOB TYPE

Full Time

SALARY

$61k-85k (estimate)

POST DATE

01/04/2024

EXPIRATION DATE

05/05/2024

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The job skills required for UTILIZATION REVIEW SPECIALIST include Clinical Documentation, etc. Having related job skills and expertise will give you an advantage when applying to be an UTILIZATION REVIEW SPECIALIST. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by UTILIZATION REVIEW SPECIALIST. Select any job title you are interested in and start to search job requirements.

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If you are interested in becoming an Utilization Review Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become an Utilization Review Specialist for your reference.

Step 1: Understand the job description and responsibilities of an Accountant.

Quotes from people on Utilization Review Specialist job description and responsibilities

Utilization Review Specialists ensure that Doctors and Nurses choose only the best treatments for them.

03/11/2022: Fort Myers, FL

Utilization review typically refers to the review of services that have already been delivered, while utilization management often refers to the review of coverage for future medical services.

02/16/2022: Louisville, KY

Assess plans for patient care and determine what treatment is appropriate and most cost-effective

02/15/2022: Augusta, GA

Analyze electronic medical records, and inform medical staff whether a medical claim is denied,

03/11/2022: Boston, MA

Prepares and submits regular reports on utilization control and on review activities.

02/26/2022: Reading, PA

Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.

Career tips from people on Utilization Review Specialist jobs

Know where to find utilization review jobs.

03/13/2022: Clarksville, TN

Create a utilization review cover letter.

02/18/2022: Reno, NV

Sign up for free credit monitoring.

03/16/2022: New London, CT

Set up documentation shortcuts.

03/05/2022: Lawton, OK

Take the certification examination.

05/08/2022: New Bedford, MA

Step 3: View the best colleges and universities for Utilization Review Specialist.

Butler University
Carroll College
Cooper Union
High Point University
Princeton University
Providence College
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