Charge Entry / AR Specialist
About The Position
We are seeking a detail-oriented and highly organized Utilization Review (UR) Coordinator / Authorization Representative [clinical experience preferred]. This role is responsible for managing authorizations, ensuring medical necessity documentation, and maintaining compliance with AHCCCS (Arizona Health Care Cost Containment System) requirements. The ideal candidate thrives in a fast-paced environment, demonstrates strong knowledge of behavioral health utilization management, and has a proven ability to manage high client volumes while maintaining strict adherence to timely filing and regulatory standards.
Requirements
- Minimum of [2+] years of experience in utilization review, authorizations, or behavioral health administration
- Clinical experience (peer service, clinician, etc.) that could aid in the review of clinical necessity.
- Strong working knowledge of AHCCCS requirements, including authorization processes and compliance standards
- Experience with timely filing requirements and payer-specific guidelines
- Proven ability to manage high caseloads and concurrent reviews in a fast-paced environment
- Familiarity with behavioral health levels of care (e.g., RTC, PHP, IOP, outpatient)
- Excellent organizational skills and attention to detail
- Strong written and verbal communication skills
- Experience with EHR systems and authorization tracking tools
- Ability to work independently and as part of a multidisciplinary team
- Time management and prioritization
- Accuracy and compliance-driven mindset
- Critical thinking and problem-solving
- Ability to handle sensitive information with confidentiality (HIPAA compliance)
- Adaptability in a high-volume, deadline-driven environment
Nice To Haves
- Experience working with Medicaid/managed care plans, specifically AHCCCS
- Knowledge of InterQual, ASAM, or other medical necessity criteria tools
- Previous experience handling denials, appeals, and peer-to-peers
Responsibilities
- Obtain, track, and manage initial and concurrent authorizations for behavioral health services
- Coordinate and complete utilization review processes in compliance with AHCCCS guidelines and medical necessity criteria
- Submit timely and accurate authorization requests, ensuring adherence to payer-specific timely filing requirements
- Monitor authorizations for expiration and proactively manage concurrent reviews to prevent gaps in coverage
- Communicate effectively with clinical staff, payers, and case managers to gather necessary documentation and ensure continuity of care
- Maintain accurate and up-to-date records in the EHR and authorization tracking systems
- Review clinical documentation for completeness and alignment with medical necessity standards
- Manage a high volume of client cases, prioritizing tasks to meet deadlines and avoid service disruptions
- Follow up on pending authorizations, denials, and appeals as needed
- Ensure compliance with all federal, state, and AHCCCS regulations, as well as internal policies and procedures
Benefits
- Opportunity to make a meaningful impact in behavioral health care
- Collaborative and mission-driven team environment
- Competitive compensation and benefits package
- Professional growth and development opportunities
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
