Job Description
**This is an on-site position**
Nextus Billing Solutions specializes in Billing and Claims services for Behavioral Health/Substance Abuse facilities. We are seeking motivated individuals with a desire to be a part of a winning team. We are a fast paced, progressive company with our main headquarters based in Boca Raton, Florida with our second location in Philadelphia, Pennsylvania.
Job Summary
The Utilization Review Senior Specialist plays a crucial role in obtaining authorizations by performing a variety of functions which incudes, but not limited to, navigating electronic medical records and advocating for the patient; communicating with insurance carriers via phone/ fax as needed and articulating medical necessities using specialized language while strictly adhering to compliance standards.
Responsibilities and Duties
- Evaluate and prepare medical records to justify medical necessity
- Advocate on the client(s) behalf to ensure services will be covered by insurance company
- Ability to adhere to HIPPA compliance standards
- Ability to articulate medical necessity using medical dialect
- Proficient in personal time management, multi-tasking and calendar organization
- Complete new admissions and concurrent reviews in a timely manner
- Review clinical information and communicate documentation needs
- Establish and maintain professional relationships with care managers
Qualifications and Skills
- Proficiency with the utilization review process
- In-depth knowledge of the Substance Abuse Facility utilization review process and/or In-depth knowledge of Mental Health utilization review process
- Familiar with ASAM / and or medical necessity criteria for each level of care
- Effective communication skills, both verbal and written via phone and email
- Proficiency utilizing related software programs such as Kipu, ZenCharts, etc.
- Microsoft Office products including Word, Excel, and Power Point
- Knowledge in computers and can navigate various software programs
Education and Experience
- Experience conducting utilization reviews in healthcare setting
- Experience working in mental health or behavioral healthcare setting
- High-school diploma
(Preferred but not required):
- Bachelor’s degree or higher in Psychology or related field
- Licensed Mental Health Clinician (LCSW, LMHC, LMFT)
- Certified Addiction Counselor or Professional (CAC, CAP, MCAP, MAC)
- Experience working in a medical billing setting
- Experience working in Substance Abuse Treatment Industry
- Experience managing caseloads of 50+ per week
- Experience obtaining an average of 200 authorizations per month
- Knowledge in day-to-day operations of a psychiatric or behavioral healthcare setting
- Comprehensive knowledge of all levels of care (Detox, RTC, PHP, IOP, OP, Aftercare)
Job Type: Full-time
Pay: From $60,000.00 per year
Benefits:
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- Day shift
- Monday to Friday
Experience:
- Mental Health Industry: 1 year (Required)
- Substance Abuse Treatment Industry: 1 year (Required)
- Utilization Review: 3 years (Required)
- Behavioral Health Industry: 1 year (Required)
Ability to Relocate:
- Boca Raton, FL 33487: Relocate before starting work (Required)
Work Location: In person