Utilization Review Representative

At Medusind we take immense pride in offering superior, cost-effective solutions covering the whole spectrum of tasks and processes to the healthcare industry. A significant factor is that our workforce comes with rich domain expertise and robust compliance norms.

Our four-prong approach of an excellent management team coupled with a detailed eye for processes experienced manpower, and cutting-edge technology helps us deliver superior, cost-effective services to our clients across the globe.

Benefits:

• Health insurance. 
• Dental insurance. 
• Employer-paid life insurance.
• Employer-paid short-term & long-term disability.
• Voluntary additional life insurance.
• Employee Assistance Program. 
• 48 hours of sick time after three months.
• 80 hours of vacation time after six months.
• $400 referral bonus.

Position Overview:

• As a Utilization Review Representative, you will be a key member of the Utilization Review Team as the face to our clients and the client’s liaison to the insurance companies.
• You must strongly advocate for increasing patient care on behalf of the patients and our clients when working with insurance companies and case managers.
• This position must demonstrate exceptional customer service skills with the ability to effectively communicate with internal and external customers.  

Role & Responsibilities:

• Successfully conduct pre-authorizations and utilization reviews of behavioral health, substance abuse and mental health cases.
• Advocate with and for our client’s patients with health insurers to obtain optimal authorization for treatment. Interfaces with clients to obtain necessary clinical documentation for reviews, outcomes and discharge planning.
• Communicates with insurance and managed care companies to inform them of diagnoses and health status of clients.
• Represent multiple facilities in utilization reviews, peer-to-peer reviews, etc. in a professional manner.
• Effectively train and influence facility treatment centers on best practices for recording medical records, increasing authorizations, etc.
• Demonstrate and value adherence to policies pertaining to patient privacy, following all HIPAA requirements.
• Other responsibilities as assigned.

• At least 2-3 years of utilization review and/or clinical experience; emphasis in dual diagnosis with mental health and substance abuse preferred.
• Must have superior customer service skills.
• DSM V Experience.
• ASAM criteria comprehension.
• Experience with pre-authorization and utilization reviews.
• Effective oral and written communication skills with prompt and professional response.
• Proficiency with Best Notes, Kipu, Availity, and Change Healthcare preferred.
• Demonstrates understanding of billing revenue codes CPT/HCPCS, diagnosis codes/lCD-10.
• Self-motivated with strong organizational skills and superior attention to detail.
• Must be able to manage multiple tasks when given.
• Capable of working within and adapting to new policies, procedures and practices prescribed by the Company.