Utilization Review Specialist

Congress Billing is a Billing Management Company focused on providing low-cost Revenue Cycle Management solutions with high professionalism, ethics, and transparency.

Location: Remote

Salary: $60,000 - $65,000

Responsibilities

• Obtaining preauthorization for admissions and continued stays according to third party guidelines within one business day of admission, including researching and obtaining 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

Requirements

• Bachelor's degree from an accredited college or university in social work, mental health, nursing, or related degree required - Master's degree preferred
• 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

Benefits

• Medical, vision, dental, life insurance, retirement plans, and PTO.
• Training and support to foster the growth of our team.
• A positive and fulfilling work environment.