Are you looking for a New Job or Looking for better opportunities?
We got a New Job Opening for
Full Details :
Company Name : Serenity Oaks Wellness Center
Location : Fort Lauderdale, FL 33314
Position : Utilization Review & Written appeal Specialist
Job Description : SUMMARY: The primary responsibility of this position is to implement the organization’s of appeals that resulted in denial during the Utilization Review(UR) process so as to ensure appropriate usage of available resources and to optimize reimbursement for services rendered in accordance with patient need. The UR coordinator monitors the client population on a daily basis and regularly checks documentation for compliance with current UR best practices. The Coordinator serves as the primarily liaison with payers in matters related to utilization, takes a lead role in organizing and conducting UR and provides regular reports to facilitate decision making by senior management. The Coordinator also assists in other key administrative functions such as handling admissions enquiries, orienting new patients and families, verification of benefits, and implementation of the organization’s performance management and improvement process.RESPONSIBILITIES: This position reports to our Director of Utilization Review and will contribute to our overall efforts through the following responsibilities:Appealing cases that resulted in a denial during the: CLINICAL DATA REVIEW – Advocate patient care by reviewing clinical data, including medical records and provider notes to understand patient history and to gain solid understanding of individual patient circumstances, needs and medical necessity for purposes of admission and or continued stay reviewsINSURANCE REVIEW CALLS – Communicate clinical information to insurance companies to obtain authorization to treat and or to facilitate continued stay. Utilize knowledge of billing process and clinical data to present viable arguments for insurance coverage.SPECIFIC AREAS OF RESPONSIBILTY- Assist director with the patients accounts to ensure that the billing and collection process proceeds in a timely, efficient manner. Problem Solving Skills – Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Uses reason even when dealing with emotional topics. Oral Communication – Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings. Addresses problems notated by the supervisorWORK SCHEDULE: This is a full-time on positionQUALIFICATIONS: 2+ years prior experience in a utilization review and appeal capacity or equivalent experience. Must demonstrate prior experience, knowledge of insurance industry, and or aptitude for effective claim advocacy.Basic understanding of the Utilization review and appeal process, prior patient care or related work experience in the substance abuse, behavioral and or mental health treatment field required.Prior experience as a behavioral health technician or other support license staff that has worked in treatment facilities is highly desirable.Strong computer skills and knowledge of MS Office products, including skills in MS Excel required. Ability to quickly navigate between platforms necessary.Strong written and verbal communication skills are a must have.College degree preferred but not required.EQUAL OPPORTUNITY EMPLOYERJob Type: Full-timePay: $23.00 – $27.00 per hourBenefits:Dental insuranceFlexible spending accountHealth insuranceLife insuranceVision insuranceMedical Specialty:PsychiatryPhysical Setting:InpatientOutpatientRehabilitation centerSchedule:Monday to FridaySupplemental Pay:Signing bonusCOVID-19 considerations:The campus follows the following guidelines of 6 ft distancing, mask requirement, daily temperature check and if symptoms are reported staff will have to test negative prior to returning.Education:High school or equivalent (Preferred)Experience:Utilization review & appeal: 1 year (Preferred)License/Certification:license (Preferred)Work Location: One location
This post is listed Under Florida jobs
Disclaimer : Localpublic.in works to publish latest job info only and is no where responsible for any errors. Users must Research on their own before joining any company