Position Summary:
The Utilization Review Coordinator is responsible for verifying consumer eligibility and securing prior authorizations for services with all third-party payers, including private insurance, Medicaid, and Medicare, across designated counties. This role acts as a critical liaison between healthcare providers, billing teams, and third-party payers to ensure timely service approvals and to assist in resolving billing issues.
Essential Duties and Responsibilities:Verify client eligibility for services with all third-party payers including private insurance, Medicaid, and Medicare.
Coordinate and secure prior authorizations for services as required by third-party payers.
Maintain up-to-date knowledge of payer requirements, documentation standards, and authorization processes.
Serve as the primary liaison between clinical staff, administrative teams, and third-party payers.
Support billing and claims resolution by identifying and addressing payer-related issues that impact reimbursement.
Communicate effectively with internal teams to ensure that authorization and billing documentation is accurate and timely.
Track and monitor authorization expirations and reauthorization needs.
Maintain accurate and confidential records of authorizations and payer communications in accordance with HIPAA and organizational policies.
Education & Experience:
This position requires either a Bachelor degree in Counseling, Psychology, Social Work, Marriage and Family Therapy or Nursing; or requires at least 2 years experience in a Behavioral Health setting. Outpatient therapist's must comply with all supervision requirements of their respective boards. Independent licensure is not required for the URC position.
Experience in Behavioral Health setting a plus; competency in working with computers and electronic devices necessary for completing their tasks; experience with Microsoft Excel; QMHP preferred; good organization and communication skills.
Knowledge, Skills, and Abilities:
Proficiency with insurance verification, medical terminology, and authorization processes.
Strong understanding of Medicaid, Medicare, and commercial insurance requirements.
Excellent communication and interpersonal skills.
Detail-oriented with strong organizational and time management skills.
...financial systems. I will perform the installation of application software and core database software upgrades, patches, and hotfixes.... ...More: The MIL Corporation is seeking a Senior Software Engineering Analyst to support a Federal Government client at our Charleston...
...and support staff ensuring adequate workflow and synergies Develop and refine an exceptional experience for customers taking delivery Proactively mediate and resolve any customer concerns or escalations Help control expenses, including staffing, supplies...
...Kickstarter is seeking a highly skilled and self-driven Creative Manager to join our dynamic team. In this role, you will be responsible... ..., and manage external creative vendors, including freelancers, agencies, and production companies, ensuring that deliverables meet...
...technology and build a more sustainable, more inclusive world. Job Description Experience performing Systems Analyst role in Data Management Strong analytical, problem solving, and documentation skills Gather and document requirements for data catalog / metadata...
...to ingest and organize permissions metadata in the Veza Authorization Graph. Global enterprises like Blackstone, Wynn Resorts, and Expedia trust Veza to visualize access permissions, monitor permissions activity, automate access reviews, and remediate privilege violations...