UR (Authorizations) Specialist I or II

Company Overview:

At Prosperity Behavioral Health, we understand the unique challenges faced by behavioral health providers and are committed to providing innovative solutions that streamline operations and enhance financial performance. By leveraging our advanced technology and industry expertise, we enable our customers to focus on providing life-changing care to those in need.

We simplify financial and billing complexity to accelerate business results and unlock patient growth.

Our mission is to transform the business side of behavioral health, allowing providers to navigate the complexities of the healthcare landscape with confidence. Whether it’s optimizing revenue cycles, improving operational efficiency, or ensuring compliance with industry standards, Prosperity Behavioral Health supports our customers every step of the way.

Join us in making a meaningful impact in the lives of countless individuals. At Prosperity Behavioral Health, you will be part of a dynamic team dedicated to driving positive change and helping our customers thrive in an ever-evolving industry.

General Purpose of Position:

Are you passionate about handling complex cases and building strong relationships with healthcare facilities? As Utilization Review Specialist II, you will take on high-profile cases and serve as an experienced team member responsible for managing the utilization review process for behavioral health services. Your demonstrated leadership skills and ability to navigate challenging situations will allow you to contribute significantly to the success of our utilization review team.

You will independently manage a full caseload of intakes and concurrent reviews, collaborating with facilities daily to provide updates and ensure compliance with authorizations for substance abuse and mental health treatment. In this role, you will play a key part in maximizing the length of treatment authorizations, ensuring accuracy in documentation, and maintaining strong communication with internal and external stakeholders.

Primary Responsibilities (include but are not limited to):

• Respond to Freshdesk tickets and emails requiring immediate attention, ensuring timely resolution.
• Maintain effective and professional communication with facilities, providing task updates, answering questions, and addressing concerns related to authorizations or assigned tasks.
• Take ownership of a full caseload of intakes and concurrent reviews, obtaining the maximum time authorizations for substance abuse and mental health treatment at all levels of care.
• Build rapport with assigned facilities through effective email and phone communication, collaborating daily to provide updates on authorizations, discharges, and clinical documentation for ongoing reviews.
• Audit charts as needed to strengthen medical records and ensure compliance with authorization requirements.
• Update the virtual binder, case notes, and all authorization documentation daily. Send daily census reports to facilities as directed by the team lead.
• Report discharges within 24 hours and document all authorizations and case notes in the OR and EMR systems.
• Complete other duties as assigned by the Utilization Review Team Lead.

Education, Skills and Experience Requirements:

• High School Diploma or equivalent (Bachelor’s Degree or higher preferred).
• 1 years of demonstrated proficiency in the Utilization Review Specialist II role or 3 years of experience in Behavioral Health Utilization Review.
• Strong organizational skills and attention to detail.
• Excellent written and verbal communication skills.
• Ability to work independently and prioritize tasks efficiently.
• Familiarity with insurance terminology and verification processes preferred.
• Proficient in navigating Google G Suite, email, and other relevant software/tools.
• Demonstrated ability to train other team members and ensure they become fully proficient in their roles.

There is opportunity for optional weekend work that is in addition to the normal Monday - Friday work.

Physical Demands and Working Environment

The conditions herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

• Physical: Primary functions require sufficient physical ability and mobility to work in an office setting; to stand or sit for prolonged periods of time; to occasionally stoop, bend, kneel, crouch, reach, and twist; to lift, carry, push, and/or pull light to moderate amounts of weight (up to 40 pounds); to operate office equipment requiring repetitive hand movement and fine coordination including use of a computer keyboard; and to verbally communicate to exchange information.
• Vision: Close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.
• Hearing: Hear in the normal audio range with or without correction.

This job description does not list all the duties of the job. You may be asked by managers to perform other instructions and duties.

Prosperity Behavioral Health provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Prosperity Behavioral Health complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person

Pay range $22.00 - $28.00 an hour depending on experience.