使用率审查专员
Utilization Review Specialist
关于我们
Congress Billing 是一家专业的账单管理公司，始终坚信客户的最佳利益。我们的使命是确保所有 Congress Billing 客户都能获得经过验证的低成本 RCM 解决方案，在最短时间内实现最大化的保险报销。我们将通过最高水平的专业性、职业道德和透明度来实现这一目标。
加入我们的团队
利用审查专员（UR 专员）负责执行利用审查流程，以确保第三方付款人提供适当的报销。这包括管理多个地点和护理级别的并发审查、拒绝/申诉流程，以及信息的流转、组织和报告。
福利
我们提供具有竞争力的薪资和福利，包括医疗、视力、牙科、人寿保险、退休计划和带薪假期。我们相信培训和支持能够促进团队的成长，并提供积极而充实的工作环境。
要求
申请 UR 专员职位需满足以下条件：
- 需要从认可的大学或学院获得社会工作、心理健康、护理或相关专业的学士学位 - 硕士学位优先
- 需要了解行为健康系统和利用管理
- 需要在医院或医疗保险公司有两年的 UR 经验
- 持有 LMSW、LMHC、LPC 或其他医疗相关执照者优先
UR 专员职责
- 在入院后一个工作日内根据第三方指南获取入院和持续住院的预授权（如另有要求除外），包括研究并获取任何必要的保险联系信息，并协调医院和保险医生之间的会议安排。
- 管理和执行回顾性授权和拒绝/申诉流程。
- 及时向相关行政和临床人员传达预授权结果、后续说明、选项及相关信息。这包括在一天内回复所有电话和邮件，除非另有要求。
- 在账单和 UR 软件中记录活动，并为会议和管理层审查准备报告。
- 对文件进行整理和归档，以便在批准的位置方便访问。
- 协助收集与预授权和报销相关的数据分析信息。
查看英文原文
About Us
Congress Billing is a sophisticated Billing Management Company that strongly believes in the best interest of their clients. Our mission is to ensure that all Congress Billings clients have a proven low-cost RCM solution that provides maximized Insurance Reimbursements in the quickest attainable time possible. We will achieve this with the highest level of professionalism, ethics, and transparency.
Join Our Team
The Utilization Review Specialist (UR Specialist) is responsible to perform the process of utilization review to ensure appropriate reimbursement by third party payers. This includes managing concurrent reviews for multiple locations and levels of care, the denial/appeals process, as well as the flow, organization, and reporting of information.
Benefits
We offer competitive pay and benefits including medical, vision, dental, life insurance, retirement plans, and PTO. We believe in training and support to foster the growth of our team, and provide a positive and fulfilling work environment.
Requirements
To be considered for the Utilization Review Specialist position, you will need:
- Bachelor's degree from an accredited college or university in social work, mental health, nursing, or related degree required - Master's degree preferred
- Knowledge of behavioral health systems and Utilization Management required.
- Two years of UR experience in a hospital or healthcare insurance setting required.
- LMSW, LMHC, LPC, or other healthcare related licensure preferred
UR Specialist Responsibilities
- Obtaining preauthorization for admissions and continued stays according to third party guidelines within one business day of admission (unless otherwise required), including researching and obtaining any necessary insurance contact information, and coordinating scheduled meetings between hospital and insurance doctors.
- Managing and performing the processes for retrospective authorizations and denials/appeals.
- Timely communicating preauthorization outcomes, follow-up instructions, options, and related information to relevant administrative and clinical staff. This includes responding to all calls and emails within one business day unless otherwise required.
- Documenting activity in Billing and UR software and preparing reports for meetings and management review.
- Organizing and filing documents for ease of access in approved locations.
- Assisting in compiling information for data analysis relating to preauthorization and reimbursement.
- Providing assistance to facility staff in determining the likelihood of insurances covering treatment.
- Maintaining patient confidentiality in accordance with state and federal law.
- Participating in internal information meetings, required in-service education and training, and company-wide performance improvement and compliance activities.
- Other duties as assigned
Pay: $60,000 - $65,000
Schedule: 9-5pm EST
Location: Remote
Apply today!
Originally posted on Himalayas