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Form of workUtilization Review Specialist-Hickory Behavioral 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
