Utilization Review Clerk - Non-Exempt

Overview

Utilization Review Representative

Pay: $20.00 - 22.00 per hour

The primary responsibility for the Utilization Review Rep is to be the liaison between the utilization review department and the stakeholders of Embark behavioral health. The basic job responsibilities will be insurance authorization (utilization review), speaking with stakeholders regarding the insurance process, submitting medical records as requested, and other duties as assigned. The utilization review rep duties will include monitoring provider documentation performance, manage daily utilization review, episodes with payors and research all "denials" with a forensic record review in a timely manner with a follow up plan of correction. The utilization review rep will ensure all documentation is following all federal and state regulations, and is in accordance with Embark BH policy and procedures.

The team member who joins the Utilization Review Department must be professional, a self starter who is able to work in a fast-paced and high stress environment, and an individual who is self motivated with the ability to multitask well. This individual must be a team player and work well in close environments with others. The purpose of this position is to help secure funds for Embark behavioral health stakeholders, which increases longevity of treatment for students and families.

About us:

Embark Behavioral Health is a leading nationwide network of outpatient centers and residential programs offering premier mental health treatment for preteens, teens, and young adults. Our ever-growing locations are part of a continuum of care that provides a range of services built from over 25 years of specialization in serving youth.

Responsibilities

• Complete pre-authorization request to third party payors

• Work to ensure all concurrent reviews are prepped and requested in a timely manner

• Ensure all potential clients receive appropriate certifications for services "to be" rendered by working closely with insurance companies, therapists and billing department

• Execute effective communication with clients/families and billing department

• Communicate regularly with the various treatment team providers

• Monitor the fulfillment of all documentation requirements

• Answer questions regarding the insurance authorization process

Qualifications

• Customer Service experience (with behavioral health experience preferred)

• Experience with the insurance utilization review process

• Knowledge of medical terminology

• HIPAA Certification (required upon employment)

• Familiar with medical terminology, diagnostic terms, and treatment modalities

• Working knowledge of Windows-based applications

• Patience and ability to manage stress and maintain confidentiality

• High School/GED REQUIRED (Associate degree preferred)

Benefits

• Enjoy a comprehensive Benefits Program, encompassing medical insurance with a generous company contribution towards a high deductible plan, dental insurance, vision insurance, voluntary life and AD&D insurance, long-term disability, 401K with company matching, and paid maternal leave.

• Revel in the balance of Company Paid Holidays and a PTO accrual schedule.

• At Embark, we and our team members embody core values of empathy, trusting relationships, service, growth, and results. Join us in making a meaningful difference.

Embark is an Equal Employment Opportunity Employer. Embark is committed to enriching the therapeutic and healing experience it offers through the diversity of its employees and community. Embark seeks to recruit and support a broadly diverse staff who will contribute to the organization's excellence, diversity of viewpoints and experiences, and relevance in a global society.