Utilization Review Specialist

hace 3 semanas

Colombia Exact Billing Solutions A tiempo completo

**Utilization Review Specialist - RBT, BCaBA, Substance Abuse Counselor**

DESCRIPTION The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers.

**RESPONSIBILITIES**
- Review chart documentation to ensure patient meets medical policy
- Prioritize incoming authorization requests according to the urgency
- Negotiate reimbursement rates with payors
- Obtain authorization via payer website or by phone and follow up regularly on pending cases
- Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations **Initiate appeals for denied authorizations**:

- Respond to clinic questions regarding payer medical policy guidelines
- Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
- Contact patients to discuss authorization status
- Other duties as assigned

**KNOWLEDGE, SKILLS, AND ABILITIES**
- Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle
- Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
- Basic understanding of human anatomy, specifically musculoskeletal
- Proficient use of CPT and ICD-10 codes
- Excellent computer skills including Excel, Word, and Internet use
- Detail oriented with above-average organizational skills
- Plans and prioritizes to meet deadlines
- Excellent customer service skills; communicates clearly and effectively
- Ability to multitask and remain focused while managing a high-volume, time-sensitive workload

**EDUCATION/EXPERIENCE REQUIRED**
- High School Diploma or GED
- 2 years of medical prior authorization experience preferred
- 2 years of experience in a medical-related field required

**Exact Billing Solutions Culture**

Exact Billing Solutions is a supercharged environment propelled by collaboration through our philosophy: “Empowering Your Ambition.” The expectation for each team member is to provide a highly supportive high-performance work environment. Exact Billing Solutions team members are charged with:

- Identifying challenges and collaborating with team members to devise creative solutions and measurable outcomes
- Motivating team members to be their best while holding them accountable to maintain the company’s excellent service standards
- Establishing and maintaining open and honest communication, always sharing information
- Continual learning, teaching and development
- Leading and driving initiatives to completion

**Technology**

Technology is an essential part of managing the needs of our business. Team members are expected to use the instruments and systems identified as efficient and effective methods to manage day-to-day operations in their role. We encourage feedback on new and emerging systems and/or instruments that may promote more efficiencies and better performance.

**HIPAA**

Team members are required to adhere to policies and procedures implementing HIPAA requirements for the privacy and security of protected health information. Team members are permitted to use and/or disclose only minimum amount of Protected Health Information necessary to complete assigned tasks.

Reports all suspected violation of company’s HIPAA policies or procedures to Human Resources.

**Environmental Stewardship and Safety**
- Team members are expected to adhere to facility safety requirements, report unsafe practices or equipment, and, if applicable, use the appropriate protective equipment as needed.
- Depending on role, and during the daily course of duties, team members may have to lift, twist, pull or push. Team members must be able to manage these activities up to 60 lbs.
- Any accident or incident must be reported immediately to a member of management for proper recording.

We offer a competitive compensation and benefits package including a base salary with performance-based incentives, medical, deal, vision, short/long-term disability, life insurance and 401(k).

Team Members excluded from Federal Healthcare Programs.

Exact Billing Solutions operates facilities that receive federal funding and may not employ or contract with an individual or entity that has been excluded from health care programs (for example, Medicare or Medicaid). Accordingly, if a team member or agent has been excluded from or is under investigation and may be excluded, they must notify a member of management immediately.
- Exact Billing Solutions is proud to be an Equal Employment Opportunity employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We embrace diversity and inclusion in a serious way. We

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