Utilization Review Coordinator

Posted 2hrs ago

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Job Description

Remote Utilization Review Coordinator supporting authorization operations for Northpoint Recovery’s behavioral healthcare services. Tracking payer approvals, documentation, and clinical record submissions.

Responsibilities:

Monitor authorization work queues, fax queues, and tracking tools for pending, approved, denied, and expiring authorizations
Track authorization dates, approved units/days, expiration dates, payer reference numbers, and other required authorization information
Identify upcoming authorization expirations and communicate deadlines or outstanding requirements to UR Specialists
Coordinate collection and submission of payer-requested clinical documentation, including progress notes, treatment plans, assessments, discharge summaries, and other records
Upload, fax, electronically transmit, or submit clinical documentation through payer portals and verify successful receipts
Perform routine payer follow-up regarding authorization status, documentation receipt, outstanding requests, and administrative requirements
Support UR Specialists in preparing and organizing documentation for initial and concurrent authorization reviews
Assist with payer portal activity, authorization verification, and non-clinical payer communication
Maintain authorization information, payer correspondence, and supporting documentation in KIPU and designated systems
Coordinate administrative requirements for peer-to-peer reviews, payer escalations, and authorization appeals
Support discharge-related UR documentation and discharge summaries of authorization records
Maintain payer reference materials, authorization requirements, workflows, and departmental resources
Assist with UR standard operating procedures, payer guides, workflows, and training materials
Provide cross-market support based on authorization volume, staffing needs, and departmental priorities
Partner with Clinical Operations, Admissions, Billing, and other RCM functions to resolve authorization issues and ensure continuity of information
Participate in departmental meetings, training, payer education, and process-improvement initiatives
Maintain patient confidentiality and comply with HIPAA, organizational policies, payer requirements, and regulatory standards
Perform other duties as assigned to support Utilization Review and Revenue Cycle Management

Requirements:

High school diploma or equivalent required
Previous experience in behavioral health, healthcare administration, utilization management, revenue cycle management, insurance verification, medical billing, payer authorization, or a related healthcare environment preferred
Experience working with commercial insurance, Medicaid, Medicare, or managed-care organizations preferred
Familiarity with behavioral health levels of care, including residential, PHP, IOP, and outpatient services, preferred
Experience with electronic medical records, payer portals, and healthcare revenue-cycle systems preferred
Experience with KIPU or similar behavioral-health EMR platforms is a plus
Strong organizational and time-management skills with the ability to manage multiple deadlines simultaneously
Exceptional attention to detail and accuracy
Ability to identify time-sensitive authorization issues and appropriately escalate concerns
Strong written and verbal communication skills
Ability to communicate professionally with payers and internal stakeholders
Working knowledge of healthcare insurance terminology, authorizations, medical necessity, and payer requirements
Ability to learn and interpret payer-specific authorization requirements
Strong computer skills and ability to work across multiple systems, payer portals, and tracking tools
Ability to maintain accurate documentation and detailed records
Strong problem-solving skills and willingness to independently research routine issues before escalation
Ability to work collaboratively in a fast-paced, multi-market environment
Demonstrated professionalism and discretion when handling confidential patient and organizational information
Ability to work Monday-Friday, 8am-5pm

Benefits:

Subsidized Health Insurance Coverage for Employee, Spouse, & Dependent(s)
100% Employer Paid Basic Life Insurance equal to 1x annual salary, up to $100,000
100% Employer Paid Employee Assistance Program
Voluntary Dental, Vision, Short-Term Disability, Supplemental Life & AD&D, Critical Illness, Accident, and Hospital Indemnity Insurance
Pre-tax Savings Accounts for all IRS-allowable medical and dependent care expenses
Generous Paid Time Off plan
Employee Referral Bonuses
401K Retirement Plan & Employer Match
Remote work arrangement

Utilization Review Coordinator

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Northpoint Recovery

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