Job Information
MMBS dba Aftermath Billing Utilization Review Specialist in Port Saint Lucie, Florida
The Utilization Review Specialist proactively monitors and assesses clinical documentation and medical records to ensure that medical necessity criteria are met for each level of care. The UR Specialist coordinates with the medical and clinical staff to prepare documentations to present to insurance companies for continued authorization. The focus of our UR Specialist is to manage the review and approval process allowing the clients clinical and medical staff time to a focus on providing the highest level of care for their clients.
Supervisory Responsibilities:
- None.
Duties/Responsibilities:
- Completes Pre-certifications, Concurrent Reviews, Peer Reviews (when applicable), Step-Ups and Step-Downs, Single Case Agreements, and communicates with facilities on what is needed for continued stay in the highest LOC.
- Proficient knowledge of ASAM, LOCUS and familiar with CALOCUS guidelines.
- Work Retrospective appeals when requested by your supervisor.
- Maximize length of stay to reduce recidivism rates within the facilities.
- Collaborate with providers, staff, and other departments to ensure that utilization review requirements are met
- Documents thoroughly in the authorization forms and updates the master work list of your team. Every call or voicemail should have a note that goes along with action taken on a case. This is to include the date, the note, your initials and time of the call or message left on the voicemail.
- Attend quarterly Utilization Review meetings along with team meetings set up by your manager.
- Builds rapport with both the Care Managers and our point people at each facility.
- Performs other duties as assigned
Required Skills/Abilities:
- Basic understanding of clerical and administrative procedures.
- Effective written and verbal communication skills.
- Detailed organizational and time management skills.
- Ability to solve problems as they arise.
- Proficient in Google Suite, Office 365, Sunwave, Zen Charts, KIPU or similar software. Willingness to learn new EMRs as they are developed.
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