What are the responsibilities and job description for the Utilization Review Specialist position at Red Rock Billing, LLC?
Company Description
Red Rock Billing is a premier behavioral health billing company based in South Jordan, Utah, specializing in comprehensive revenue cycle management services for behavioral health providers. Our expert team works with mental health professionals, addiction treatment centers, and other behavioral health organizations to streamline billing processes, optimize reimbursements, and ensure compliance with evolving healthcare regulations. By combining deep knowledge of both clinical and financial aspects of behavioral health, we offer customized solutions that boost operational efficiency, reduce administrative burdens, and improve cash flow. This enables providers to focus more on delivering exceptional patient care.
About the Role:
We are seeking a detail-oriented and clinically knowledgeable Utilization Review Specialist to join our team on a part-time basis. This position offers the potential to transition into a full-time role within the next few months, based on performance and organizational needs. It is ideal for a licensed therapy professional who excels at clinical documentation, understands medical necessity criteria, and communicates effectively with insurance companies.
Key Responsibilities:
- Conduct utilization reviews and authorization requests with insurance companies for various levels of care.
- Review clinical documentation to ensure it meets payer requirements and reflects medical necessity.
- Communicate clearly and professionally with insurance representatives, treatment teams, and internal staff.
- Track authorization deadlines and maintain accurate records of approvals, denials, and ongoing reviews.
- Collaborate with clinicians to gather necessary information or clarify clinical details.
- Stay informed on insurance policies, clinical criteria, and utilization management best practices.
Required Qualifications:
- Must be local to Utah.
- Bachelor’s or Master’s degree in a therapy-related field (e.g., Social Work, Marriage & Family Therapy, Clinical Mental Health Counseling, Psychology, or related).
- Active or eligible Utah licensure preferred (e.g., CSW, ACMHC, AMFT, LCSW, CMHC, LMFT).
- Strong clinical writing and documentation skills.
- Excellent communication, organization, and time-management abilities.
Preferred Qualifications:
- Prior experience in utilization review, case management, insurance authorization, or related clinical administrative roles.
- Familiarity with insurance payer guidelines and medical necessity criteria (e.g., ASAM, InterQual).
Schedule & Compensation:
- Part-time hours; flexible schedule available.
- Potential to grow into a full-time position within a few months.
- Compensation dependent on experience.
How to Apply:
Please submit your resume and a brief cover letter describing your relevant experience and interest in the position.