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    Behavioral Health- Utilization Review Representative - Orlando, United States - Medusind

    Medusind
    Medusind Orlando, United States

    2 weeks ago

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    Description

    Job Description

    Job DescriptionDescription:

    At Medusind we take immense pride in offering superior, cost-effective solutions covering the whole spectrum of tasks and processes to the healthcare industry. A significant factor is that our workforce comes with rich domain expertise and robust compliance norms.

    Our four-prong approach of an excellent management team coupled with a detailed eye for processes experienced manpower, and cutting-edge technology helps us deliver superior, cost-effective services to our clients across the globe.

    Benefits:

    • Health insurance.
    • Dental insurance.
    • Employer-paid life insurance.
    • Employer-paid short-term & long-term disability.
    • Voluntary additional life insurance.
    • Employee Assistance Program.
    • 48 hours of sick time after three months.
    • 80 hours of vacation time after six months.
    • $400 referral bonus

    Position Overview:

    • As a Utilization Review Representative, you will be a key member of the Utilization Review Team as the face to our clients and the client's liaison to the insurance companies.
    • You must strongly advocate for increasing patient care on behalf of the patients and our clients when working with insurance companies and case managers.
    • This position must demonstrate exceptional customer service skills with the ability to effectively communicate with internal and external customers.

    Role & Responsibilities:

    • Successfully conduct pre-authorizations and utilization reviews of behavioral health, substance abuse and mental health cases.
    • Advocate with and for our client's patients with health insurers to obtain optimal authorization for treatment. Interfaces with clients to obtain necessary clinical documentation for reviews, outcomes and discharge planning.
    • Communicates with insurance and managed care companies to inform them of diagnoses and health status of clients.
    • Represent multiple facilities in utilization reviews, peer-to-peer reviews, etc. in a professional manner.
    • Effectively train and influence facility treatment centers on best practices for recording medical records, increasing authorizations, etc.
    • Demonstrate and value adherence to policies pertaining to patient privacy, following all HIPAA requirements.
    • Other responsibilities as assigned.
    Requirements:
    • At least 2-3 years of utilization review and/or clinical experience; emphasis in dual diagnosis with mental health and substance abuse preferred.
    • Must have superior customer service skills.
    • DSM V Experience
    • ASAM criteria comprehension
    • Experience with pre-authorization and utilization reviews.
    • Effective oral and written communication skills with prompt and professional response.
    • Proficiency with Best Notes, Kipu, Availity, and Change Healthcare preferred.
    • Demonstrates understanding of billing revenue codes CPT/HCPCS, diagnosis codes/lCD-10
    • Self-motivated with strong organizational skills and superior attention to detail.
    • Must be able to manage multiple tasks when given.
    • Capable of working within and adapting to new policies, procedures and practices prescribed by the Company.
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