Utilization Review Coordinator/ Authorization Specialist (Full time)

Job Summary:

The Utilization Review (UR) Coordinator is responsible for ensuring that mental health and substance abuse treatment services provided by the facility are medically necessary, appropriately documented, and covered under insurance authorizations. This role involves performing initial, concurrent, and retrospective reviews, obtaining authorizations, monitoring client progress, and ensuring compliance with regulatory and payer requirements.

The UR Coordinator works closely with clinical and administrative teams to facilitate smooth communication with insurance companies, prevent denials, and maintain up-to-date, accurate documentation to secure reimbursement and minimize revenue loss. Responsibilities also include entering charges, billing for commercial payors, and following up on submitted claims to ensure proper and timely payment. This position plays a key role in maximizing revenue through accurate billing practices and active claims management.

Key Responsibilities:

Utilization Review & Authorization Management

· Obtain initial authorizations and secure ongoing approval for continued treatment by submitting timely, accurate clinical information to insurance companies, managed care organizations (MCOs), and other third-party payers.

· Ensure that services rendered remain covered under active authorizations by tracking expiration dates, managing re-authorizations, and addressing gaps in approval.

· Monitor length of stay, treatment plans, and service utilization to ensure compliance with payer guidelines and internal protocols.

· Enter charges and bill claims accurately weekly

· Claims management

· A/R Claim follow up

Job Types: Full-time, Part-time

Pay: $19.00 - $23.00 per hour

Benefits:
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: Remote

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