Utilization Review Specialist

About Us

Congress Billing is a sophisticated Billing Management Company that strongly believes in the best interest of their clients. Our mission is to ensure that all Congress Billing’s clients have a proven low-cost RCM solution that provides maximized Insurance Reimbursements in the quickest attainable time possible. We will achieve this with the highest level of professionalism, ethics, and transparency.

Join Our Team

The Utilization Review Specialist (UR Specialist) is responsible to perform the process of utilization review to ensure appropriate reimbursement by third party payers. This includes managing concurrent reviews for multiple locations and levels of care, the denial/appeals process, as well as the flow, organization, and reporting of information.

Benefits

We offer competitive pay and benefits including medical, vision, dental, life insurance, retirement plans, and PTO. We believe in training and support to foster the growth of our team, and provide a positive and fulfilling work environment.

Requirements

To be considered for the Utilization Review Specialist position, you will need:

• Master's degree from an accredited college or university in social work, mental health, nursing, or related degree Required.
• Knowledge of behavioral health systems and Utilization Management required.
• Two years of UR experience in a hospital or healthcare insurance setting required.
• LMSW, LMHC, LPC, or other healthcare related licensure preferred

UR Specialist Responsibilities

• Obtaining preauthorization for admissions and continued stays according to third party guidelines within one business day of admission (unless otherwise required), including researching and obtaining any necessary insurance contact information, and coordinating scheduled meetings between hospital and insurance doctors.
• Managing and performing the processes for retrospective authorizations and denials/appeals.
• Timely communicating preauthorization outcomes, follow-up instructions, options, and related information to relevant administrative and clinical staff. This includes responding to all calls and emails within one business day unless otherwise required.
• Documenting activity in Billing and UR software and preparing reports for meetings and management review.
• Organizing and filing documents for ease of access in approved locations.
• Assisting in compiling information for data analysis relating to preauthorization and reimbursement.
• Providing assistance to facility staff in determining the likelihood of insurances covering treatment.
• Maintaining patient confidentiality in accordance with state and federal law.
• Participating in internal information meetings, required in-service education and training, and company-wide performance improvement and compliance activities.
• Other duties as assigned

Pay: 60,000-70,000

Schedule: Full time

Location: Remote

Apply today!