Utilization Review Coordinator

Pathways complies with all applicable federal, state, and local laws and provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, ancestry, age, disability, pregnancy status, victim status, marital status, member of the armed services or covered veteran status, or any other status that is protected by applicable federal, state, and/or local laws. This policy includes, but is not limited to: recruitment, employment, promotion, demotion, transfer, termination, compensation, benefits, layoffs, training, and social and recreational programs.

Job Title: Utilization Review Coordinator

Salary Range: $32,000 - $40,000

Position Summary:

The Utilization Review Coordinator is responsible for verifying consumer eligibility and securing prior authorizations for services with all third-party payers, including private insurance, Medicaid, and Medicare, across designated counties. This role acts as a critical liaison between healthcare providers, billing teams, and third-party payers to ensure timely service approvals and to assist in resolving billing issues.

Essential Duties and Responsibilities:

• Verify client eligibility for services with all third-party payers including private insurance, Medicaid, and Medicare.

• Coordinate and secure prior authorizations for services as required by third-party payers.

• Maintain up-to-date knowledge of payer requirements, documentation standards, and authorization processes.

• Serve as the primary liaison between clinical staff, administrative teams, and third-party payers.

• Support billing and claims resolution by identifying and addressing payer-related issues that impact reimbursement.

• Communicate effectively with internal teams to ensure that authorization and billing documentation is accurate and timely.

• Track and monitor authorization expirations and reauthorization needs.

• Maintain accurate and confidential records of authorizations and payer communications in accordance with HIPAA and organizational policies.

Qualifications:

Education & Experience:

• This position requires either a Bachelor degree in Counseling, Psychology, Social Work, Marriage and Family Therapy or Nursing; or requires at least 2 years experience in a Behavioral Health setting. Outpatient therapist's must comply with all supervision requirements of their respective boards. Independent licensure is not required for the URC position.

• Experience in Behavioral Health setting a plus; competency in working with computers and electronic devices necessary for completing their tasks; experience with Microsoft Excel; QMHP preferred; good organization and communication skills.

Knowledge, Skills, and Abilities:

• Proficiency with insurance verification, medical terminology, and authorization processes.

• Strong understanding of Medicaid, Medicare, and commercial insurance requirements.

• Excellent communication and interpersonal skills.

• Detail-oriented with strong organizational and time management skills.