JOB DESCRIPTION
The Utilization Review Coordinator conducts continued stay reviews of medical record documentation using pre-established criteria and provides updated progress reports to third party payers in order to receive certification for payment. He or she must be client focused, team oriented, dependable, and focused on compliance and performance quality with great interpersonal and communication skills. In addition, he or she must be flexible to sudden changes in workload, emergencies, or staffing and have good problem solving skills.
The ideal candidate for this position has Bachelor's degree (BA) in Behavioral Health, Master's Degree preferred with 1 year of direct drug and alcohol, billing and previous utilization review experience. He or she must be proficient in Microsoft Office, have strong organization skills, and be able to make decisions and work independently. Knowledge of facility systems and organization as they pertain to medical records and organization review and knowledge of medical terminology and medical record format and content required.
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RESPONSIBILITIES
Maintains accurate and thorough work logs of all reviews conducted with emphasis on documentation of service, days authorized, and authorization numbers
Performs concurrent continued stay reviews using pre-established criteria, understands ASAM criteria, and communicates this information accurately to insurance carriers
Consults with appropriate treatment team members for clarification of documentation as needed
Exchanges information with Finance Office concerning insurance company requirements and all policies pertaining to certifications and appeals and inputs data accurately for financial purposes
Maintains accurate review sheets of all reviews performed
Helps supervisor and departments identify patterns of mis-utilization
Responds to telephone messages quickly, professionally, and appropriately
Participates in continuing education to reach professional growth objectives by attending in-services and other training opportunities
Participates in task forces and committees as assigned
Attends case conference for clinical updates
Maintains and communicates authorization information to all team members
Monitors/flags charts for high quality documentation when needed on a regular basis, regardless of reviews required
Educates new staff members about ASAM criteria, high-quality documentation, and insurance needs
Works in an environment with risk of exposure to communicable disease and possible exposure to intoxicated, disruptive, and/or agitated patients
Performs other duties as assigned
Qualification
Bachelor's degree (BA) in Behavioral Health required, Master's Degree preferred with 1 year of direct drug and alcohol experience, billing and previous utilization review experience.
Knowledge of 12-step recovery and an understanding of chemical dependency
Knowledge of facility systems and organization as they pertain to medical records and organization review
Knowledge of medical terminology and medical record format and content
Excellent computer, internet, and business software skills
Excellent customer-facing and phone skills
Communication and interpersonal skills to develop relationships with patients, staff, and providers
Strong organization skills with a proven ability to multi-task and manage time to meet frequently changing deadlines in a fast-paced environment