Utilization Review - Los Angeles, United States - Codemax Medical Billing

Codemax Medical Billing

Verified Company

Los Angeles, United States

16 hours ago

Posted by:

Mark Lane

beBee recruiter

Description

Job Title:
Utilization Review Specialist

Reports to:
Utilization Review Supervisor

Employment Status:
Full-Time

FLSA Status:
Non-Exempt

Job Summary:_

CodeMax Medical Billing is seeking to hire an experienced Utilization Review Specialists or Licensed Medical Clinicians to be trained as a Utilization Review Specialists.

We specialize in Behavioral Health and Mental Health treatment Facilities that provide Detoxification, Residential Treatment, Partial Hospitalization, Intensive Outpatient, Outpatient Treatment, Eating Disorder Outpatient and Inpatient Programs, Mental Health Outpatient Programs.

Duties/Responsibilities:_
Collaborates with the clinical team to determine coverage and length of stay.
Utilizes clinical information and knowledge of Behavioral and Mental Health Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and health care partners.
Collaborates in Continuing Care planning.
Works with facility staff to ensure timely admissions.
Prepares and submits appeals documentation to the appropriate entities as indicated.
Submits and reports insurance authorization according to company policy.
All other duties as assigned.
Required Skills/Abilities:_
Proficiency in healthcare management systems and Microsoft Office Suite.
Strong organizational and multitasking skills.
Excellent verbal and written communication abilities.
Education And Experience:_
1 year of experience in Behavioral Healthcare or any other medical field with a rigorous preauthorization process.
Medical or Clinical License (required); LMFT, AMFT, CADC, RN, LPN

A minimum of 1 year of experience in Behavioral Healthcare or any other medical field with a rigorous preauthorization process.
A minimum of 1 year of experience in Behavioral Healthcare Utilization Review or any other medical field with a rigorous preauthorization process.
Medical or Clinical License (preferred); LMFT, AMFT, CADC, RN, LPN

A minimum of 1 year of experience in Behavioral Healthcare or any other medical field with a rigorous preauthorization process.

A minimum of 1 year of experience as a Referral Coordinator or Clinical Coordinator in Behavioral Healthcare or any other medical field with a rigorous preauthorization process.

Benefits: