Utilization Management Specialist

The Company You’ll Join

The OCD and Anxiety Centers has a true passion for bringing help and hope to some of the most underserved clinical populations. We strive to change the lives of individuals and their families who have been suffering from unrelenting anxiety, disturbing and terrifying thoughts, uncontrollable worry, exhausting behaviors and rituals, and avoidance that keep them from living their lives. We are an evidence-based practice, which means we do what works, we stay up to date with scientific research, and we regularly attend international training to keep us at our very best.

Our Investment in You

• A competitive base salary starting at $18.00 per hour, depending on experience
• 401k match
• Core benefits: medical/dental/vision, with the company contribution to medical benefits for employee
• Company-paid employee life insurance
• Voluntary benefits
• Paid time off includes 15 days (120 hours) of “Paid Time Off,” 5 days (40 hours) of “Sick Time,” and 9 days (72 hours) “Company holiday” pay
• Paid specialized ongoing training, strengthening your skills, experiences, and connections that will help advance your career

The Purpose of Your Role

The UM specialist is an advocate who works with clients and commercial insurance payors to obtain approval for proper treatment services. They promote quality, cost-effective care strategies to payers using evidence-based criteria to meet the care guidelines. They are the company’s connection between health care providers, clients, and insurance companies. After the provider determines the appropriate level of care during the intake, the UM specialist works with the client through the full approval cycle to help the payor identify medical necessity, appropriateness, and reasonableness of services recommended by the provider. They have a thorough knowledge of payer policies, guidelines, appeals, corrected/voided claim submission, and up-to-date on all-payer changes.

The UM specialist demonstrates excellent customer service skills and communicates professionally and efectively.

The UM specialist required effective communication and coordination with the Director of Utilization Management, with fellow UM specialists, insurance companies, and the treatment team to obtain the maximum benefit for our clients. The individual in this position has overall responsibility for utilization performance improvement, denied authorizations, and operational management of The OCD and Anxiety Treatment Centers Utilization Management Department. The position entails coordinating and managing concurrent and retrospective reviews of all client’s medical records over the continuum of care. The UM specialist is responsible for completing admission, concurrent and peer reviews as well as initiating denials and appeals. The UM specialist ensures cases are reviewed and responded to in a timely and clinically sound manner in accordance with policies and procedures.

Objectives:

• Collect data on variances in LOC, lost days, cost/barriers to discharge and denied days.
• Schedules and completes peer-to-peer reviews and coordinates crucial appeals.
• Initiate single-case agreements and work collaboratively with payer relations team to execute rates and secure authorization.
• Reviews clinical documentation.
• Review the quality of documentation provided to assure adequacy and clinical appropriateness for current LOC.
• Coordinates with the treatment team, billing, and clients to obtain proper documentation and authorizations
• Coordinates benefits and transition between various levels of care.
• Communicates all UM related information with the treatment team to share updates with clients and families regarding the status of current authorization.
• Ensure that all deficiencies identified through the performance improvement analysis are addressed with appropriate problem-solving actions.

Required:

• High school diploma or equivalent
• 2+ years experience in customer service, billing, or utilization review
• Familiarity with medical terminology and medical billing practices
• Prior knowledge of computers, including Microsoft Word, Excel, and other computer software
• Accurate and efficient electronic data entry
• Must be punctual and maintain excellent attendance
• Organized, detail-oriented, takes initiative, and completes job responsibilities independently
• Multitask, problem-solve, interpersonal skills, and strong written and verbal communication skills maintain confidentiality and trustworthiness
• Physical demands of the job include sitting at a desk or table for extended periods, bending, lifting, and walking
• Pass a full criminal background check
• Eligible to work in the US

Preferred Qualifications:

• Proven experience as a billing coordinator or similar position
• Active SUDC, ASUDC, CSW, LCSW, CMHC, ACMHC, RN, or LPN license
• Working knowledge of EMR software
• Team management and leadership skills

Equal Employment Opportunity Commission (EEOC) statement

The OCD and Anxiety Centers is committed to providing equal opportunity for all employees and applicants without regard to race, color, religion, sex, national origin, age, marital status, sexual orientation, genetics, disability, political affiliation, personal appearance, family responsibilities, or any other legally protected class under federal, state, or local law. This applies to all aspects of employment, including recruitment, hiring, job assignments, promotions, working conditions, scheduling, benefits, wage and salary administration, disciplinary action, termination, social, educational, and recreational programs.

Website

https://www.theocdandanxietytreatmentcenter.com/