What are the responsibilities and job description for the Utilization Review Specialist position at Warriors Heart?
Warriors Heart - is a Private Adult Drug & Alcohol Treatment that exclusively treats our Nations Hero’s - Active-Duty Military, Veterans, Law Enforcement, Fire Fighters and First Responders.
The facility is hiring a Utilization Review Specialist.
Pay ranges depending on experience/qualifications.
Qualifications to Include but not limited to:
- 2 or more years’ experience billing UR healthcare industry – in mental health/addiction arena.
- Active pre-certification and utilization review experience.
- Working knowledge of clinical case formulation for substance abuse/mental health treatment.
-Working knowledge of managed care in all areas (VOB, Pre-Certification, ASAM Criteria, Addiction/Mental health terminology)
- Familiar with ICD-9 codes, billing codes, DSM VI TR diagnostic codes
- Ability to prioritize, multi-task and meet strict deadlines. Strong Organization skills and dedication to continuous learning in field.
- Able to pass a Background Clearance
- Maintain & exceed individual JCAHO compliance, Texas Dept. State Health Services compliance, and other regulatory agencies
- Advanced Computer Skills (mac platforms, word, excel, etc.). Excellent data entry skills.
- Knowledge of HIPAA Guidelines and federal substance abuse treatment confidentiality guidelines.
Duties to Include but not limited to:
- Verification of Insurance Benefits (ability to help if available)
- Speaking with Clients/Financial Responsible Party
- Pre-Certification of treatment if required by insurance company
-Authorization for treatment at all levels of care based off medical necessity
-Concurrent reviews as required
-Proper documentation of all interactions with insurance parties
- Knowledge of billing documentation
- Release of clinical/medical records to appropriate agencies and requests
- Verification of correct information in electronic health record
-Tracking of all clients and authorizations
-Working with Insurance department as a team
www.WarriorsHeart.com
Job Type: Full-time
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
Experience:
- Insurance verification: 1 year (Preferred)
- Medical coding: 1 year (Preferred)
- Addiction/Chemical Dependency: 1 year (Preferred)
- Military/1st Responder: 1 year (Preferred)
Work Location: In person
