- Degreein behavioral health or nursing preferred, or related education and/or experience.
- Minimum 1 year of experience with utilization review in a health care provider or insurance environment required
- Eating disorders experience preferred.
- LICSW, LISW, RN preferred.
- Review client medical records to gather the necessary information to support prior authorization requests for intensive (IOP and PHP), residential, and inpatient treatment.
- Complete concurrent reviews for intensive (IOP and PHP), residential, and inpatient treatment, striving to obtain coverage for the recommended length of stay.
- Provide discharge notification to insurance companies as requested.
- Coordinate scheduling peer-to-peer reviews with insurance and Accanto clinical team members.
- Communicate with insurance reviewers regarding clinical information requested and to resolve issues related to coverage.
- Collaborate with the clinical team to a) highlight any information that would strengthen the case for authorization, b) trigger the clinical team to add it to the client's medical record, c) present the additional, compelling information to the insurer.
- Ensure insurance benefits are current and active for incoming admissions and partner with the Client Access Team regarding any issues.
- Develop and maintain strong and productive working relationships with review agencies.
- Maintain up-to-date expertise and knowledge of health insurance company requirements, preferences, criteria, and strategies to support successful completion of authorizations.
- Complete daily updates to the Census Web App to ensure the Admissions Coordinator Team has the necessary authorization information to support successful admissions to intensive (IOP and PHP), residential, and inpatient treatment.
- Participate in the onboarding and orientation of new team members, including training and mentoring new URs as assigned.
- Provide back-up support to UR colleagues during times of PTO or vacancy.
- Partner with the Accanto Medical Records and Revenue Cycle Management departments on authorization related appeals.
- Coordinate with Specialty Access Services and Client Access on benefit related issues and single case agreements.
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Utilization Reviewer - St Paul, United States - The Emily Program
Description
Position Summary:The Utilization Reviewer (UR) is a strong advocate for clients to access medically necessary care by pursuing insurance authorizations for recommended treatment. The UR is responsible for obtaining prior authorizations and concurrent review authorizations for intensive outpatient, partial hospitalization, residential, and inpatient eating disorder treatment for Accanto Health. This position is critical for ensuring that clients can access the care they need for the recommended length of treatment.
Schedule:
REMOTE
Full-time, 40 hours/week
Monday-Friday, 8am-4:30pm Central Time Zone
Experience & Education:
