Address
Form of work
SalaryUtilization Review Specialist-Hickory Network
Direct Report to Corporate Utilization Review Coordinator
Primary Purpose and Function:
The UR Specialist is responsible for daily data entry, treatment authorization tracking, discharge summary submissions to payor sources, and daily EMR chart audits.
Minimum Qualifications:
- High school diploma or equivalent required, Bachelor's degree in social work, mental health/behavioral sciences, or related field, preferred.
- Minimum two years of experience working in an office setting.
- Computer proficiency, including Excel, Word, Publisher, and PowerPoint required
- An ability to learn quickly, multi-task, and utilize effective communication skills, including both telephone and in-person
- Positive demeanor and clear understanding of team- oriented environment
- Schedule flexibility, holiday, and weekend rotation is REQUIRED
Primary Responsibilities:
- Communicate with Intake Department to gather clinical information regarding documentation, plan of care, and discharge planning.
- Enter new admission and discharge information onto main census spreadsheet.
- Submit daily discharge summaries to insurance within 24 hours of discharge, including appropriate documentation required by insurance contracts.
- Maintain accurate documentation of approvals and denials within Client Portal, Shared Drive, and main census spreadsheet
- Assist with tracking denials, unused days, appeals, and retroactive requests and assist billers with authorization discrepancies.
- Follow up with insurance providers as needed for any pending authorization issues
- Address all incoming faxes and e-mails.
- Participate in monthly supervision with UR Coordinator.
Pay Band: Full Time- $35,000-$42,000
As this is not an all-inclusive list. Other duties may be assigned as required by Patient and Facility needs.
