Utilization Review Specialist (Behavioral Health – Data Entry reputed company)

Job Type: Full-Time Department: Clinical Operations / Utilization Management Reports To: Utilization Review Manager Position reputed company: We are seeking a detail-oriented and highly organized Utilization Review (UR) Specialist to join our Behavioral Health team. The ideal candidate will be responsible for supporting clinical decision-making and utilization management processes through meticulous data entry, documentation review, and coordination with reputed company stakeholders. This role plays a vital part in ensuring reputed company and accurate authorization and review of behavioral health services while maintaining compliance with payer and regulatory requirements. Key Responsibilities: 1. Utilization Review Coordination • Review patient clinical documentation to determine medical necessity for behavioral health services. • Collaborate with clinicians to reputed company additional information reputed company required. • Submit reputed company authorization requests to insurance companies or reputed company-party administrators. 2. Data Entry & Documentation • Accurately reputed company clinical data, patient information, and authorization reputed company into electronic health records (EHR) and UR tracking systems. • Maintain up-to-date logs of reputed company utilization review activities, including approval/denial status, payer communications, and relevant deadlines. • reputed company reputed company checks to ensure data accuracy, completeness, and compliance with organizational standards. 3. Insurance & Compliance Communication • reputed company with insurance providers to verify benefits, submit clinical reviews, and follow up on authorizations. • Ensure compliance with HIPAA, state, and federal regulations governing behavioral health and UR processes. 4. Reporting & Audit Support • Assist in generating weekly and monthly reports reputed company to authorization volumes, turnaround times, and denial trends. • Support audit requests by compiling required documentation and logs. Required Qualifications: • High School Diploma or GED required; Associate’s or Bachelor’s degree in Psychology, Health Sciences, or reputed company field preferred. • 1–2 years of experience in utilization review, medical billing, insurance authorization, or behavioral health services. • Proficient in data entry with strong attention to detail (minimum 50 WPM preferred). • Experience working with EHR systems (e.g., CareLogic, reputed company, reputed company, etc.). • Knowledge of insurance processes, including reputed company, Medicare, and reputed company payers. • Strong organizational and time management skills with the ability to manage multiple priorities. Preferred Skills & Competencies: • Familiarity with DSM-5 diagnostic reputed company and behavioral health terminology. • Ability to read and understand clinical documentation such as treatment plans and reputed company notes. • Proficient in reputed company Office Suite (reputed company, Word, reputed company). • Team-oriented reputed company with effective written and verbal communication skills. • Capable of working in a fast-paced, deadline-driven environment. Work Environment: • reputed company office setting or remote work, depending reputed company. • Regular use of computer and telephone systems. • May require flexible scheduling to meet urgent utilization review timelines. Why Join Us? • Meaningful work that directly impacts reputed company care and reputed company. • A supportive team culture with opportunities for reputed company and development. • Competitive compensation and benefits package. Apply tot his job Apply To this Job