Utilization Review Representative

At Medusind we take immense pride in offering superior, cost-effective solutions covering the whole spectrum of tasks and processes to the healthcare industry.

A significant factor is that our workforce comes with rich domain expertise and robust compliance norms.

Our four-prong approach of an excellent management team coupled with a detailed eye for processes experienced manpower, and cutting-edge technology helps us deliver superior, cost-effective services to our clients across the globe.

Benefits :

• Health insurance.
• Dental insurance.
• Employer-paid life insurance.
• Employer-paid short-term & long-term disability.
• Voluntary additional life insurance.
• Employee Assistance Program.
• 48 hours of sick time after three months.
• 80 hours of vacation time after six months.
• $400 referral bonus.

Job Details : This position has an expected start date of November 15, 2024.

Position Overview :

• As a Utilization Review Representative, you will be a key member of the Utilization Review Team as the face to our clients and the client’s liaison to the insurance companies.
• You must strongly advocate for increasing patient care on behalf of the patients and our clients when working with insurance companies and case managers.
• This position must demonstrate exceptional customer service skills with the ability to effectively communicate with internal and external customers.

Role & Responsibilities :

• Successfully conduct pre-authorizations and utilization reviews of behavioral health, substance abuse and mental health cases.
• Advocate with and for our client’s patients with health insurers to obtain optimal authorization for treatment. Interfaces with clients to obtain necessary clinical documentation for reviews, outcomes and discharge planning.
• Communicates with insurance and managed care companies to inform them of diagnoses and health status of clients.
• Represent multiple facilities in utilization reviews, peer-to-peer reviews, etc. in a professional manner.
• Effectively train and influence facility treatment centers on best practices for recording medical records, increasing authorizations, etc.
• Demonstrate and value adherence to policies pertaining to patient privacy, following all HIPAA requirements.
• Other responsibilities as assigned.

Requirements :

• At least 2-3 years of utilization review and / or clinical experience; emphasis in dual diagnosis with mental health and substance abuse preferred.
• Must have superior customer service skills.
• DSM V Experience.
• ASAM criteria comprehension.
• Experience with pre-authorization and utilization reviews.
• Effective oral and written communication skills with prompt and professional response.
• Proficiency with Best Notes, Kipu, Availity, and Change Healthcare preferred.
• Demonstrates understanding of billing revenue codes CPT / HCPCS, diagnosis codes / lCD-10.
• Self-motivated with strong organizational skills and superior attention to detail.
• Must be able to manage multiple tasks when given.
• Capable of working within and adapting to new policies, procedures and practices prescribed by the Company.

About Medusind :

Since 2002, organizations across the entire healthcare spectrum have leveraged our deep expertise and high-quality solutions to maximize revenue, reduce operating costs and navigate the changing healthcare landscape.

Medusind’s unique combination of deep industry expertise, robust operational capability, and client-focused service significantly improves the efficiency and profitability of healthcare organizations.

Client satisfaction is the primary focus of the Medusind leadership and staff.Our highly experienced personnel, cutting edge technology, and forward thinking approach allows us to deliver effective solutions while staying ahead of healthcare industry changes.