Demo

Utilization Review Specialist

ICBD Holdings LLC
Fort Lauderdale, FL Full Time
POSTED ON 1/19/2025
AVAILABLE BEFORE 4/20/2025

Description

Utilization Review Specialist - Exact Billing Solutions

Lauderdale Lakes, FL

About Exact Billing Solutions

Exact Billing Solutions is a unique team of medical billing professionals specializing in the substance use disorder, mental health, and autism fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies.

Growth Opportunity in Cutting-Edge Medical Billing

If you're an experienced clinician looking to forge a new career path where your clinical knowledge is valued, consider our Utilization Review Specialist position.

As a Utilization Review Specialist, you will play a pivotal role in ensuring the efficient and effective utilization of healthcare resources. You will be responsible for reviewing and evaluating clinical documentation, treatment plans, and medical records to optimize patient care and streamline healthcare delivery processes.

What You Will Do

Clinical Documentation Review :

  • Evaluate and analyze medical records, treatment plans, and clinical documentation to ensure accuracy and compliance with established standards.
  • Collaborate with healthcare providers to gather additional information or clarification on documentation when necessary.

Utilization Review :

  • Assess the appropriateness and necessity of healthcare services, ensuring they align with established guidelines and policies.
  • Identify and communicate potential issues related to overutilization or underutilization of services.
  • Collaboration and Communication :

  • Work closely with interdisciplinary teams, Board Certified Behavior Analysts, Registered Behavior Technicians, and other healthcare professionals to gather insights and ensure comprehensive reviews.
  • Communicate findings and recommendations clearly and effectively to internal teams and external stakeholders.
  • Quality Improvement :

  • Participate in quality-improvement initiatives to enhance the overall efficiency and effectiveness of healthcare delivery.
  • Provide feedback and suggestions for process improvements based on review findings.
  • Regulatory Compliance :

  • Stay informed on relevant healthcare regulations, guidelines, and accreditation standards.
  • Ensure compliance with all applicable laws and regulations in the utilization review process.
  • Requirements

    Education / Experience and Other Requirements

  • Proven experience in utilization review or a related field with a strong understanding of healthcare service delivery and documentation processes is highly desirable.
  • Up-to-date knowledge of relevant healthcare regulations, guidelines, and accreditation standards.
  • Understanding of compliance requirements and the ability to ensure adherence during the utilization review process.
  • Must maintain clean background / drug screenings and driving record.
  • Expertise Needed

  • Familiarity with industry standards, guidelines, and best practices related to utilization review.
  • Ability to analyze complex clinical documentation, treatment plans, and medical records.
  • Strong critical thinking skills to assess the appropriateness and necessity of healthcare services.
  • Excellent communication and interpersonal skills.
  • Ability to work collaboratively in a team-oriented environment.
  • If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution. Compensation Planning
    Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right. Surveys & Data Sets

    What is the career path for a Utilization Review Specialist?

    Sign up to receive alerts about other jobs on the Utilization Review Specialist career path by checking the boxes next to the positions that interest you.
    Income Estimation: 
    $82,286 - $101,931
    Income Estimation: 
    $129,132 - $174,611
    Income Estimation: 
    $64,196 - $89,573
    Income Estimation: 
    $69,387 - $87,587
    Income Estimation: 
    $82,286 - $101,931
    Income Estimation: 
    $82,286 - $101,931
    Income Estimation: 
    $129,132 - $174,611
    View Core, Job Family, and Industry Job Skills and Competency Data for more than 15,000 Job Titles Skills Library

    Job openings at ICBD Holdings LLC

    ICBD Holdings LLC
    Hired Organization Address Fort Lauderdale, FL Full Time
    Description Digital Marketing Manager, Email Automation / Talent Acquisition - ABA Centers of America Fort Lauderdale, F...
    ICBD Holdings LLC
    Hired Organization Address Bridgewater, NJ Full Time
    Description Administrative Assistant - ABA Centers of New Jersey Bridgewater, New Jersey Growth Opportunity- Entry-Level...
    ICBD Holdings LLC
    Hired Organization Address Braintree, MA Full Time
    Description IT Support Specialist II - ABA Centers of America Braintree, MA Growth Opportunity Are you an experienced IT...
    ICBD Holdings LLC
    Hired Organization Address Kissimmee, FL Full Time
    Description Registered Behavior Technician (RBT) Manager - ABA Centers of Florida Celebration, FL Leadership Opportunity...

    Not the job you're looking for? Here are some other Utilization Review Specialist jobs in the Fort Lauderdale, FL area that may be a better fit.

    Utilization Review Specialist

    CodeMax Medical Billing, Fort Lauderdale, FL

    Utilization Review Follow-Up Specialist

    CodeMax Medical Billing, Fort Lauderdale, FL

    AI Assistant is available now!

    Feel free to start your new journey!