Utilization Review Specialist (Tampa)

Job Details Location: Tampa, FL 33612 Position Type: Full Time Salary Range: $45,000.00 - $60,000.00 Salary Job Shift: Day The URS is responsible for creating and managing the flow of revenue for each client at Clean Recovery centers through liaison with insurance companies. The roles include establishing a file on all incoming clients with insurance, maintaining authorization for reimbursement from pre-certification through continuing stay reviews and discharge of referral, and using communication, reading, and writing skills to establish the most appropriate reimbursement for the level of care being provided. Responsibilities Review medical necessities and medical record documentation, and communicate health concerns to obtain necessary information. Call insurance companies to obtain precertification or concurrent authorization for the level of care. Attend team meetings to gain information and provide training to clinicians regarding data needs. Establish positive relationships with insurance providers. Identify trends in reimbursements and report to supervisor through verbal communication and generation of graphics. Address denials promptly and obtain necessary additional medical history to overturn denials. Follow up and communicate treatment plans to insurance payors for ongoing authorization. Ensure prompt communication to management on denials or payor issues. Work closely with all departments. Maintain accurate records of all transactions and communications with insurances. Accurately transfer all information to the billing department. Utilize insurance company portals such as Payspan, Zelis, and other portals. Use Microsoft Word, Outlook, and Excel. Use Adobe software. Report to work as assigned and maintain a professional workplace. Maintain acceptable overall attendance. Attend in-service and educational training as necessary and assigned. Report personal symptoms of suspected illnesses and contagious diseases to supervisor. Report incidents, accidents, and occurrences in accordance with policy and procedure. Maintain safety of the physical environment. Independently solve problems and follow through. Perform other duties and tasks as assigned. Qualifications High School Diploma or equivalent. Experience with ASAM and LOCUS criteria. Ability to interpret ASAM, LOCUS InterQual, 12-step, and treatment planning for SUD and MH and apply information to patient authorizations. Effective teamwork, communication, organizational, and interpersonal skills. Ability to work under stressful conditions and be flexible in relation to department needs. Understanding of medical and behavioral health terminology. Knowledge of state and federal statutes regarding patient confidentiality. Attention to detail. Preferred experience in behavioral health initial and concurrent review processes. #J-18808-Ljbffr Clean Recovery Centers