What are the responsibilities and job description for the Utilization Review Specialist position at TRIBE RECOVERY SERVICES INC.?
Overview
Title: Billing Utilization Specialist (Substance Use and Mental Health Services)
General Purpose:
- Make sure services provided (like therapy, IOP, detox, MAT, etc.) are properly documented, billed, and reimbursed.
- Review clinical documentation to ensure it matches insurance requirements.
- Maximize reimbursement while staying fully compliant with healthcare laws and payer contracts.
Key Responsibilities:
- Utilization Review: Check that services are medically necessary and authorized by insurance.
- Billing Coordination: Submit claims, correct billing errors, follow up on denied claims.
- Documentation Support: Help clinicians document services in a way that meets insurance and accreditation standards.
- Compliance Monitoring: Stay up-to-date with Medicaid, Medicare, and private insurance rules.
- Authorization Management: Track and request pre-authorizations and continued stay authorizations.
- Reporting: Create utilization reports for leadership, showing trends, billing patterns, or problem areas.
Skills Needed:
- Strong knowledge of ICD-10, CPT coding, and payer requirements (especially Medicaid/Medicare).
- Experience with behavioral health EMRs (like Kareo, Kipu, SimplePractice, or similar).
- Attention to detail and organizational skills.
- Ability to work closely with clinical and administrative staff.
Job Type: Full-time
Pay: $31.27 - $33.97 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
Schedule:
- 8 hour shift
People with a criminal record are encouraged to apply
Ability to Commute:
- Denver, CO 80204 (Required)
Ability to Relocate:
- Denver, CO 80204: Relocate before starting work (Required)
Work Location: In person
Salary : $31 - $34