Job description
Spectrum Billing Solutions is an industry-leading revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing team. The UR Supervisor will provide supervision and support to the UR team as well as utilize his or her knowledge and skills to obtain initial and continuing authorizations for behavioral healthcare services. The ideal candidate is passionate, motivated, detail-oriented and interested in working in a cohesive and rewarding environment.
This is a remote/hybrid position.
Responsibilities include:
- Provide planning, direction and priority setting for the UR team
- Assist with development and implementation of training programs, policies, guidelines, and processes.
- Provide support to staff in handling escalations and/or issues.
- Review patient admission and clinical information to ensure medical necessity and compliance of utilization review guidelines.
- Obtain initial and continuing authorization for treatment services.
- Manage authorization denials including referral for peer review.
- Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment.
- Interact with insurance companies in a respectful, professional manner that facilitates the utilization review process and follows policies and procedures.
- Document and record all necessary information.
- Monitor and track new and ongoing authorization cases.
- Collaborate and communicate with clinical staff to ensure necessary information is obtained and timely reviews are performed.
- Assist the treatment team in understanding payer requirements for admission, continued stay and discharge planning.
- Participate in team meetings and case conference reviews.
Minimum requirements:
- 3-5 years of experience in utilization review for behavioral health services.
- Bachelor’s or Master’s degree.
- Superior written and oral communication skills
- Attention to detail to ensure necessary information is captured and properly documented.
- Ability to work independently and within a team.
- Ability to multi-task, prioritize and meet expected deadlines.
- Solid understanding of insurance benefits and coverages.
- Strong computer skills (Word, Excel, billing software).
- Understanding of mental and behavioral health treatment services.
At Spectrum, you receive:
- A close-knit team of talented and skilled individuals.
- Growth opportunities within the organization.
- Competitive salary.
- Healthcare benefits including medical, dental & vision
- 401K Plan
- Flexible PTO.
