Utilization Review Specialist

Job description:

Our mission at Interface Billing Solutions is to empower healthcare organizations through the art and science of Revenue Cycle Management. We believe in a future where financial stability and patient care excellence coexist seamlessly. With unwavering dedication, innovative solutions, and a relentless commitment to integrity, we inspire our clients and employees to thrive, driving positive change in the healthcare industry. Together, we reimagine possibilities, ensuring that every patient's journey is met with financial clarity, and every organization's vision becomes a reality.

Job Summary:

We are seeking a dedicated and passionate individual to join our team as a Utilization Review Specialist focusing in serving our clients in the mental health and substance abuse industry. This is an excellent opportunity for someone looking to further their career in healthcare and revenue cycle management with a focus on these specialized areas. This role requires a proactive and results-driven individual with a learner’s mindset who can work strategically and collaboratively with both client and internal teams to achieve maximum authorization for patients’ treatment services.

Responsibilities:

· Conduct thorough reviews of patient records to ensure compliance with established treatment guidelines and quality standards.

· Collaborate with clinical staff to gather necessary information for utilization review purposes.

· Assess the appropriateness and necessity of treatment plans and services provided to patients.

· Review and analyze clinical documentation to support the authorization of services and determine the level of care required.

· Stay informed about industry regulations and guidelines related to utilization review.

Qualifications:

· Bachelor's degree in a related field (Social Work, Psychology, Nursing, etc.) preferred.

· Proven experience in utilization review within the mental health and chemical dependency field.

· Strong knowledge of healthcare regulations and accreditation standards.

· Excellent interpersonal skills and strong communication.

· Results-oriented with a focus on meeting deadlines.

· Ability to work independently and collaboratively in a team-oriented environment.

· Proficient in working in a digital environment and using multiple software for productivity, communication, and documentation.

· Excellent organizational and time-management skills.

· Works with a sense of duty – values strong attention to detail.

· Works with a sense of urgency and prioritizes time-sensitive deadlines.

· Ability to multitask, prioritize, and remain organized.

· Excellent analytical, communication, and problem-solving skills.

· Ability to work in a fast-paced environment and willingness to learn and adapt.

What We Offer:

· Competitive pay and performance-based incentives with accelerated opportunities for growth based on meritocracy with less focus on seniority.

· Comprehensive benefits package, including health/dental/vision insurances, and 401(K).

· Ongoing professional development opportunities.

· A positive and collaborative work environment focused on making a difference.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance