Utilization Review Coordinator
Job Description
- CLINICAL DATA REVIEW – Review clinical data, including medical records, patient charts 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 advocacy.
- INSURANCE 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.
- APPEALS ADVOCACY – Speak with clinicians at insurance company upon denial of coverage to communicate relevant clinical information and bring light to individualized patient issues that necessitate coverage for prior treatment. Utilize facts to communicate in knowledgeable, persistent, passionate and or creative manner to achieve desired results for client base.
Job Requirements
- 4 + years prior experience in a utilization review capacity or equivalent experience. Must demonstrate prior experience, knowledge of insurance industry, and or aptitude for eCective claim advocacy.
- Understanding of the Utilization review 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, verification specialist or appeals specialist and/or other support staC in treatment facilities is highly desirable.
- Strong computer skills and knowledge of MS OCice 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.
- Medical and or clinical background/education is preferred but not required.
Meet Your Recruiter
Melissa Matos
Hello – I am Melissa Matos and I love what I do – recruiting in the Healthcare space and putting people to work! I was born in Puerto Rico and raised in New York, then I moved to sunny South Florida 20+ years ago where I’ve been with Lloyd since 2002. I work closely with clients and candidates to understand the talent and career needs of both groups. My bilingual fluency is an asset to positions where a second language is critical to the regional culture and busines demands. Healthcare is one of the fastest growing industries in the U.S.; my searches and placement successes are nationwide. I head up an outstanding group of recruiters focused on the healthcare community. We know we have made an impact on our client’s workforces and are proud of the contributions our healthcare talent has made, particularly during the pandemic. We look forward to a world of wellness! #LIVINGLLOYD
Song I can listen to over & over: Anything by Marc Anthony (Salsa music!)