Utilization Review Coordinator

This is a fully remote position, open to applicants in Idaho.

📋 Description

• Oversee authorization work queues, fax queues, and tracking tools for pending, approved, denied, and expiring authorizations.

• Monitor authorization dates, approved units/days, expiration dates, payer reference numbers, and other essential authorization details.

• Recognize impending authorization expirations and inform UR Specialists about deadlines or outstanding requirements.

• Organize the collection and submission of clinical documentation requested by payers, including progress notes, treatment plans, assessments, discharge summaries, and other relevant records.

• Upload, fax, electronically transmit, or submit clinical documentation via payer portals and confirm successful receipt.

• Conduct regular follow-ups with payers regarding authorization status, documentation receipt, outstanding requests, and administrative obligations.

• Assist UR Specialists in preparing and arranging documentation for initial and concurrent authorization evaluations.

• Help with payer portal activities, authorization verification, and non-clinical communication with payers.

• Keep authorization information, payer correspondence, and supporting documents organized in KIPU and other designated systems.

• Manage administrative needs for peer-to-peer reviews, payer escalations, and authorization appeals.

• Aid in the documentation of discharge-related UR activities and summarize authorization records.

• Maintain payer reference materials, authorization requirements, workflows, and departmental resources.

• Contribute to UR standard operating procedures, payer guides, workflows, and training materials.

• Provide cross-market support based on authorization volume, staffing requirements, and departmental priorities.

• Collaborate with Clinical Operations, Admissions, Billing, and other RCM functions to address authorization issues and guarantee continuity of information.

• Engage in departmental meetings, training sessions, payer education, and process improvement initiatives.

• Uphold patient confidentiality and adhere to HIPAA, organizational policies, payer requirements, and regulatory standards.

• Carry out additional duties as assigned to support Utilization Review and Revenue Cycle Management.

⛳️ Requirements

• A high school diploma or equivalent is required.

• Prior experience in behavioral health, healthcare administration, utilization management, revenue cycle management, insurance verification, medical billing, payer authorization, or a related healthcare field is preferred.

• Experience with commercial insurance, Medicaid, Medicare, or managed-care organizations is preferred.

• Familiarity with behavioral health levels of care, including residential, PHP, IOP, and outpatient services is preferred.

• Experience utilizing electronic medical records, payer portals, and healthcare revenue-cycle systems is preferred.

• Experience with KIPU or similar behavioral health EMR platforms is a plus.

• Strong organizational and time management abilities, with the capacity to handle multiple deadlines concurrently.

• Exceptional attention to detail and precision.

• Capability to identify time-sensitive authorization challenges 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.

• Proficient computer skills and the ability to navigate multiple systems, payer portals, and tracking tools.

• Capacity to maintain accurate documentation and detailed records.

• Strong problem-solving skills and a proactive approach to independently researching routine issues before escalation.

• Ability to work collaboratively in a dynamic, multi-market environment.

• Demonstrated professionalism and discretion while managing confidential patient and organizational information.

• Availability to work Monday through Friday from 8 AM to 5 PM.

🏝️ 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.