UR Specialist

Sunshine Behavioral Health • San Juan Capistrano, CA

1d

About The Position

The Utilization Review Coordinator is responsible for communicating substance abuse and mental health clinical information to managed care/insurance companies and payer services to obtain authorization for treatment services provided by Sunshine Behavioral Health. The Utilization Review Coordinator must be familiar with admissions pre-certification process as well as concurrent and discharge reviews. Extensive knowledge of medical terminology, substance abuse and mental health disorders, ASAM criteria and ICD-10 diagnosis codes is necessary.

Requirements

• A minimum of twoyearof experience with Utilization Review.
• HS Diploma, college degree preferred.
• Excellent customer service skills.
• Valid Driver’s License.
• Possessproficiencyin Excel,Wordand electronic charting.
• Demonstrateabilityto multi-task.
• Demonstrateabilityto work with minimal supervision.
• Basic knowledge of HIPAA.
• Possess excellent customer service skills.
• Demonstrateabilityto work under pressure.

Responsibilities

• Complete assessments and pre-certifications for clients.
• Communicate necessary information received toappropriate staffina timelyand efficientmatter.
• Demonstrate understanding of medical terminology.
• Demonstrate understanding of policy deductibles, co-pays, co-insurance and out of pocket maximums, out of network deductions and exclusions.
• Demonstrate knowledge of EOB interpretation.
• Daily use of ten key, dataentryand spreadsheets applications.
• Communicate effectively with peers andsupervisorto address billing and claim issues.
• Follow all HIPAA, compliance,privacyand confidentiality standards.
• Participate indevelopmentof Quality Improvement projects.
• Follow all practices detailed inthe companiesPolicies and Procedures Manual and Employee Handbook.
• Attend andparticipatein staff meetings andtrainings.
• Demonstrateexpertisein Psychiatric and Addiction Disorders.
• Engage inappropriate writtenand verbal communication with families, insurance companies and otherprofessional.
• Demonstrateabilityto work with Excel,Wordand electronic chanting.
• Ability to work with minimal supervision.
• Organized and detail oriented.
• Other dutiesas assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED
• Number of Employees: 11-50 employees