Job DescriptionThe responsibility of a Utilization Review Specialist is to provide detailed clinical information to insurance companies to obtain the highest level of care and the longest length of stay for our client's patients.Responsibilities: Conduct Utilization / Concurrent reviews with insurance companies for substance abuse treatment.Perform concurrent review for all patients to determine the medical necessity and appropriateness of admission based criteria and standards.Daily email communication with facilities providing updates.Work in a team environment, providing assistance to numerous facilities and teammatesNegotiate with insurance companies to achieve the highest levels of care for the client based upon ASAM and other criteria.Conduct continuous reviews of patient progress and communicate this information to insurance companies to achieve the longest possible treatment stay for the patient.· Accesses EMR and follows protocol· Adheres to documentation protocol, notates accounts and reports appropriately· Participates in companywide and departmental meetings· Commits to providing excellent customer service while maintaining the highest degree of professionalism while working in a team environment to meet goals· Understands and complies with all HIPAA rules and regulations Requirements/Qualifications:Knowledge of DSM VKnowledgeable in using Microsoft OfficePay strong attention to detailAbility to work with a team in a fast pace environmentKnowledgeable of commercial insurance company guidelinesAbility to work as part of a dynamic teamProven track record of success in the substance abuse and mental health industry About ReliaBillReliaBill Solutions is a rapidly growing full-service billing and utilization review company located in Delray Beach, Florida. We are looking for additional team members in the south Florida region. ReliaBill Solutions is an equal opportunity employer and a drug-free workplace.Compensation commensurate with experience
Important Safety Tips: You should find out as much as you can about the company. Meet your prospective employers/employees face to face. You should NOT have to provide your bank account details. Stay safe - read our safety tips.