Utilization Review Specialist
Posted on Sep 25, 2024 by Woods Services
Langhorne, PA
Other
Immediate Start
Annual Salary
Full-Time
Overview:
We want you to join our team! We need deeply compassionate, committed, and highly talented staff. The Woods organization is guided by their mission to support children and adults with disabilities or challenges to achieve their highest potential and independence through innovative and individualized approaches that promote learning and personal fulfillment.
Benefits
Medical, Dental, Vision Insurance
Life and Disability Insurance
PTO - Paid time off
On-site FREE medical center
403b retirement plan
Continuing education programs
Tuition assisted program
Career growth opportunities
Salary: Starting salary $50000 / Annually depending upon education and experience
Job Summary
The Utilization Review Specialist will examine medical and behavioral health insurance benefits to ensure proper coverage, address lapses in coverage, manage authorization process, billing process, decipher complicated insurance laws and policies including Medicare, Medicaid, Behavioral Health Coverage, and Commercial Health Insurance Coverage.
Responsibilities:
Manages pre-authorization and review process for commercial and managed health care providers including identification of contacts and contract procedures and packet submissions.
Develops and maintains contracts with health care providers including adherence to all policies and procedures to enroll as a provider and maintain enrollment.
Works directly with Contract Administrators on managed and commercial insurance contracts and single case agreements.
Works directly with families, guardians, and agencies to ensure proper insurance coverage, coordination of benefits, billing procedures, and disputes.
Works directly with nursing department, care coordination department and finance department to ensure coverage is utilized, care is provided by proper providers, and that any accompanying bills/payments are managed.
Acts as a liaison between insurance member, families, fiscal, residential, and providers
Handles unique funding/authorization issues as needed.
Schedules and conducts clinical meetings and ongoing ISP meetings as needed.
May involve appeals and coordination of peer to peer reviews.
In coordination with the treatment team, the UR specialist will be responsible for identification of community resources, coordinating transition and submitting funding packets for those lower levels of service.
All other duties as assigned
Qualifications:
Must be able to lift 50 pounds.
Bachelor’s Degree in Social Work or related field with five or more years of experience with insurance verification, managed & commercial health plan procedures, and/or contract compliance.
Master’s degree preferred.
Experience working with commercial and managed health care benefits
Experience with pre-authorization and review process for continued stay
Ability and knowledge of contracting for services
Knowledge of commercial and public health benefits and membership qualifications
Coordination of Benefits
Ability to work with agencies and families to ensure, apply for, and dispute coverage
Comprehensive understanding of insurance-based terminology and coding
Computer, communications, analytical, and comprehension skills
Travel required.
About Woods Services
Woods Services is a Pennsylvania and New Jersey-based non-profit population health network and advocacy organization that along with its six affiliate organizations provides life-long innovative, comprehensive, and integrated health, education, housing, workforce, behavioral health, and case management services to more than 22,000 children and adults in the intellectual and developmental disability, child welfare, behavioral and brain trauma public health sectors who have complex and intensive medical and behavioral healthcare needs.
Our Langhorne campus is home to 550 residents and provides outpatient and day programs.
We want you to join our team! We need deeply compassionate, committed, and highly talented staff. The Woods organization is guided by their mission to support children and adults with disabilities or challenges to achieve their highest potential and independence through innovative and individualized approaches that promote learning and personal fulfillment.
Benefits
Medical, Dental, Vision Insurance
Life and Disability Insurance
PTO - Paid time off
On-site FREE medical center
403b retirement plan
Continuing education programs
Tuition assisted program
Career growth opportunities
Salary: Starting salary $50000 / Annually depending upon education and experience
Job Summary
The Utilization Review Specialist will examine medical and behavioral health insurance benefits to ensure proper coverage, address lapses in coverage, manage authorization process, billing process, decipher complicated insurance laws and policies including Medicare, Medicaid, Behavioral Health Coverage, and Commercial Health Insurance Coverage.
Responsibilities:
Manages pre-authorization and review process for commercial and managed health care providers including identification of contacts and contract procedures and packet submissions.
Develops and maintains contracts with health care providers including adherence to all policies and procedures to enroll as a provider and maintain enrollment.
Works directly with Contract Administrators on managed and commercial insurance contracts and single case agreements.
Works directly with families, guardians, and agencies to ensure proper insurance coverage, coordination of benefits, billing procedures, and disputes.
Works directly with nursing department, care coordination department and finance department to ensure coverage is utilized, care is provided by proper providers, and that any accompanying bills/payments are managed.
Acts as a liaison between insurance member, families, fiscal, residential, and providers
Handles unique funding/authorization issues as needed.
Schedules and conducts clinical meetings and ongoing ISP meetings as needed.
May involve appeals and coordination of peer to peer reviews.
In coordination with the treatment team, the UR specialist will be responsible for identification of community resources, coordinating transition and submitting funding packets for those lower levels of service.
All other duties as assigned
Qualifications:
Must be able to lift 50 pounds.
Bachelor’s Degree in Social Work or related field with five or more years of experience with insurance verification, managed & commercial health plan procedures, and/or contract compliance.
Master’s degree preferred.
Experience working with commercial and managed health care benefits
Experience with pre-authorization and review process for continued stay
Ability and knowledge of contracting for services
Knowledge of commercial and public health benefits and membership qualifications
Coordination of Benefits
Ability to work with agencies and families to ensure, apply for, and dispute coverage
Comprehensive understanding of insurance-based terminology and coding
Computer, communications, analytical, and comprehension skills
Travel required.
About Woods Services
Woods Services is a Pennsylvania and New Jersey-based non-profit population health network and advocacy organization that along with its six affiliate organizations provides life-long innovative, comprehensive, and integrated health, education, housing, workforce, behavioral health, and case management services to more than 22,000 children and adults in the intellectual and developmental disability, child welfare, behavioral and brain trauma public health sectors who have complex and intensive medical and behavioral healthcare needs.
Our Langhorne campus is home to 550 residents and provides outpatient and day programs.
Reference: 202415144
https://jobs.careeraddict.com/post/95574216
Utilization Review Specialist
Posted on Sep 25, 2024 by Woods Services
Langhorne, PA
Other
Immediate Start
Annual Salary
Full-Time
Overview:
We want you to join our team! We need deeply compassionate, committed, and highly talented staff. The Woods organization is guided by their mission to support children and adults with disabilities or challenges to achieve their highest potential and independence through innovative and individualized approaches that promote learning and personal fulfillment.
Benefits
Medical, Dental, Vision Insurance
Life and Disability Insurance
PTO - Paid time off
On-site FREE medical center
403b retirement plan
Continuing education programs
Tuition assisted program
Career growth opportunities
Salary: Starting salary $50000 / Annually depending upon education and experience
Job Summary
The Utilization Review Specialist will examine medical and behavioral health insurance benefits to ensure proper coverage, address lapses in coverage, manage authorization process, billing process, decipher complicated insurance laws and policies including Medicare, Medicaid, Behavioral Health Coverage, and Commercial Health Insurance Coverage.
Responsibilities:
Manages pre-authorization and review process for commercial and managed health care providers including identification of contacts and contract procedures and packet submissions.
Develops and maintains contracts with health care providers including adherence to all policies and procedures to enroll as a provider and maintain enrollment.
Works directly with Contract Administrators on managed and commercial insurance contracts and single case agreements.
Works directly with families, guardians, and agencies to ensure proper insurance coverage, coordination of benefits, billing procedures, and disputes.
Works directly with nursing department, care coordination department and finance department to ensure coverage is utilized, care is provided by proper providers, and that any accompanying bills/payments are managed.
Acts as a liaison between insurance member, families, fiscal, residential, and providers
Handles unique funding/authorization issues as needed.
Schedules and conducts clinical meetings and ongoing ISP meetings as needed.
May involve appeals and coordination of peer to peer reviews.
In coordination with the treatment team, the UR specialist will be responsible for identification of community resources, coordinating transition and submitting funding packets for those lower levels of service.
All other duties as assigned
Qualifications:
Must be able to lift 50 pounds.
Bachelor’s Degree in Social Work or related field with five or more years of experience with insurance verification, managed & commercial health plan procedures, and/or contract compliance.
Master’s degree preferred.
Experience working with commercial and managed health care benefits
Experience with pre-authorization and review process for continued stay
Ability and knowledge of contracting for services
Knowledge of commercial and public health benefits and membership qualifications
Coordination of Benefits
Ability to work with agencies and families to ensure, apply for, and dispute coverage
Comprehensive understanding of insurance-based terminology and coding
Computer, communications, analytical, and comprehension skills
Travel required.
About Woods Services
Woods Services is a Pennsylvania and New Jersey-based non-profit population health network and advocacy organization that along with its six affiliate organizations provides life-long innovative, comprehensive, and integrated health, education, housing, workforce, behavioral health, and case management services to more than 22,000 children and adults in the intellectual and developmental disability, child welfare, behavioral and brain trauma public health sectors who have complex and intensive medical and behavioral healthcare needs.
Our Langhorne campus is home to 550 residents and provides outpatient and day programs.
We want you to join our team! We need deeply compassionate, committed, and highly talented staff. The Woods organization is guided by their mission to support children and adults with disabilities or challenges to achieve their highest potential and independence through innovative and individualized approaches that promote learning and personal fulfillment.
Benefits
Medical, Dental, Vision Insurance
Life and Disability Insurance
PTO - Paid time off
On-site FREE medical center
403b retirement plan
Continuing education programs
Tuition assisted program
Career growth opportunities
Salary: Starting salary $50000 / Annually depending upon education and experience
Job Summary
The Utilization Review Specialist will examine medical and behavioral health insurance benefits to ensure proper coverage, address lapses in coverage, manage authorization process, billing process, decipher complicated insurance laws and policies including Medicare, Medicaid, Behavioral Health Coverage, and Commercial Health Insurance Coverage.
Responsibilities:
Manages pre-authorization and review process for commercial and managed health care providers including identification of contacts and contract procedures and packet submissions.
Develops and maintains contracts with health care providers including adherence to all policies and procedures to enroll as a provider and maintain enrollment.
Works directly with Contract Administrators on managed and commercial insurance contracts and single case agreements.
Works directly with families, guardians, and agencies to ensure proper insurance coverage, coordination of benefits, billing procedures, and disputes.
Works directly with nursing department, care coordination department and finance department to ensure coverage is utilized, care is provided by proper providers, and that any accompanying bills/payments are managed.
Acts as a liaison between insurance member, families, fiscal, residential, and providers
Handles unique funding/authorization issues as needed.
Schedules and conducts clinical meetings and ongoing ISP meetings as needed.
May involve appeals and coordination of peer to peer reviews.
In coordination with the treatment team, the UR specialist will be responsible for identification of community resources, coordinating transition and submitting funding packets for those lower levels of service.
All other duties as assigned
Qualifications:
Must be able to lift 50 pounds.
Bachelor’s Degree in Social Work or related field with five or more years of experience with insurance verification, managed & commercial health plan procedures, and/or contract compliance.
Master’s degree preferred.
Experience working with commercial and managed health care benefits
Experience with pre-authorization and review process for continued stay
Ability and knowledge of contracting for services
Knowledge of commercial and public health benefits and membership qualifications
Coordination of Benefits
Ability to work with agencies and families to ensure, apply for, and dispute coverage
Comprehensive understanding of insurance-based terminology and coding
Computer, communications, analytical, and comprehension skills
Travel required.
About Woods Services
Woods Services is a Pennsylvania and New Jersey-based non-profit population health network and advocacy organization that along with its six affiliate organizations provides life-long innovative, comprehensive, and integrated health, education, housing, workforce, behavioral health, and case management services to more than 22,000 children and adults in the intellectual and developmental disability, child welfare, behavioral and brain trauma public health sectors who have complex and intensive medical and behavioral healthcare needs.
Our Langhorne campus is home to 550 residents and provides outpatient and day programs.
Reference: 202415144
Share this job:
Alert me to jobs like this:
Amplify your job search:
Expert career advice
Increase interview chances with our downloads and specialist services.
Visit Blog