The Role
Review clinical records to determine medical necessity for ABA and behavioral health services, obtain and manage initial and continuing authorizations, handle denials and peer review referrals, document cases, track authorizations, liaise with clinical staff and payers, and ensure HIPAA compliance.
Summary Generated by Built In
Spectrum Billing Solutions offers industry-leading revenue cycle management services for healthcare providers. Our team has deep industry knowledge, technology, and experience to ensure our client’s revenue cycle is managed in the most efficient and streamlined manner.
We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will utilize his or her knowledge and skills to review clinical information and obtain initial and continuing authorizations for ABA and related services. The ideal candidate is passionate, motivated, detail-oriented and interested in working in a cohesive and rewarding environment.
This is a fully remote or office/home hybrid position.
Your Responsibilities:
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Spectrum Billing Solutions offers industry-leading revenue cycle management services for healthcare providers. Our team has deep industry knowledge, technology, and experience to ensure our client’s revenue cycle is managed in the most efficient and streamlined manner.
We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will utilize his or her knowledge and skills to review clinical information and obtain initial and continuing authorizations for ABA and related services. The ideal candidate is passionate, motivated, detail-oriented and interested in working in a cohesive and rewarding environment.
This is a fully remote or office/home hybrid position.
Your Responsibilities:
- Review patient admission and clinical information to ensure medical necessity and compliance of utilization review guidelines.
- Obtain initial and continuing authorization for treatment services.
- Manage authorization denials including referral for peer review.
- Document and record all necessary information.
- Monitor and track new and ongoing authorization cases.
- Collaborate and communicate with clinical staff to ensure necessary information is obtained and timely reviews are performed.
- Assist external clients in understanding payer requirements for authorizations.
- Participate in team meetings.
- Maintain confidentiality of patient information and adhere to HIPAA regulations.
- Flexible work environment
- Competitive Salary
- A close-knit team of talented and skilled individuals.
- Growth opportunities
- Benefits – Medical, Dental, Vision
- Flexible Paid Time Off
- 401K with Company match
- Supplemental Benefits
- 3-5 years of related ABA and/or Behavioral Health experience.
- Bachelor’s or master’s degree preferred.
- Superior written and oral communication skills
- Attention to detail to ensure necessary information is captured and properly documented.
- Ability to work independently and within a team.
- Ability to multi-task, prioritize and meet expected deadlines.
- Solid understanding of insurance benefits and coverages.
- Strong computer skills (Word, Excel, billing software).
- Understanding of mental and behavioral health treatment services.
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Skills Required
- 3-5 years of related ABA and/or Behavioral Health experience.
- Bachelor's or master's degree preferred.
- Superior written and oral communication skills
- Attention to detail to ensure necessary information is captured and properly documented.
- Ability to work independently and within a team.
- Ability to multi-task, prioritize and meet expected deadlines.
- Solid understanding of insurance benefits and coverages.
- Strong computer skills (Word, Excel, billing software).
- Understanding of mental and behavioral health treatment services.
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The Company
What We Do
Spectrum Billing Solutions is a data-driven revenue cycle management partner that utilizes industry relationships, specialty analytics, and transparency dashboards to provide our clients a strong understanding of not only their own data, but billing and reimbursement patterns, industry trends, and risks and opportunities within their market. We help our clients be proactive rather than reactive. Our full Spectrum of Services can be integrated and customized to ensure relief of unnecessary operational burden while optimizing revenue. Contact us today to learn how partnering with Spectrum can give you the advantage you need
