ABA Utilization Review Specialist

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Spectrum Billing Solutions offers industry-leading revenue cycle management services for healthcare providers. Our team has deep industry knowledge, technology, and experience to ensure our client’s revenue cycle is managed in the most efficient and streamlined manner.

We are seeking to add an ABA Utilization Review Specialist to our growing team. The ABA Utilization Review Specialist will utilize his or her knowledge and skills to review clinical information and obtain initial and continuing authorizations for ABA and related services. The ideal candidate is passionate, motivated, detail-oriented and interested in working in a cohesive and rewarding environment.

This is a fully remote or office/home hybrid position.

Your Responsibilities:

• Review patient admission and clinical information to ensure medical necessity and compliance of utilization review guidelines.
• Obtain initial and continuing authorization for treatment services.
• Manage authorization denials including referral for peer review.
• Document and record all necessary information.
• Monitor and track new and ongoing authorization cases.
• Collaborate and communicate with clinical staff to ensure necessary information is obtained and timely reviews are performed.
• Assist external clients in understanding payer requirements for authorizations.
• Participate in team meetings.
• Maintain confidentiality of patient information and adhere to HIPAA regulations.

What we offer you:

• Flexible work environment
• Competitive Salary
• A close-knit team of talented and skilled individuals.
• Growth opportunities
• Benefits – Medical, Dental, Vision
• Flexible Paid Time Off
• 401K with Company match
• Supplemental Benefits

Qualifications:

• 3-5 years of Utilization Review experience.
• ABA and/or Behavioral Health experience preferred.
• Bachelor’s or master’s degree preferred.
• Superior written and oral communication skills
• Attention to detail to ensure necessary information is captured and properly documented.
• Ability to work independently and within a team.
• Ability to multi-task, prioritize and meet expected deadlines.
• Solid understanding of insurance benefits and coverages.
• Strong computer skills (Word, Excel, billing software).

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Originally posted on Himalayas