Saanzz Digital is currently hiring a UR Specialist for one of its clients named Zealie based in the US.

About Zealie

Zealie is a fast-growing Medical Billing Services company specializing in the Behavioral Healthcare industry. Zealie's service clients are substance use disorder treatment, addiction recovery, and mental health treatment centers that are saving lives on a daily basis.

Zealie's state of the art proprietary technology provides data analytics and revenue prediction tools to its clients to help them make strategic business decisions to grow their business.

Job Summary

The UR Specialist plays a crucial role in obtaining authorizations by performing a variety of functions including but not limited to, navigating electronic medical records and advocating for the patient; communicating with insurance carriers via phone, fax, and web portals as needed and articulating medical necessities using specialized language while strictly adhering to compliance standards.

Following Zealie’s UR process, the UR Specialist is responsible for the upkeep of all authorization notes, their days authorized, and next review dates . They assess continued treatment for clients that do not require authorization, and contact the facilities for more information as needed.

Responsibilities and Duties:

● Communicate with facilities assigned to you in order to obtain authorizations.

● Follow Zealie’s UR process to document the dates and times contact was made to facilitate authorization.

● Understand and communicate the verification of benefits to the facility if the need arises.

● Understand the retro authorization and appeal process.

● Facilitate and undertake peer reviews, or peer review scheduling.

● Collaborate with facility treatment teams, to manage the clients level of care.

● Understand medical necessity as it pertains to insurance authorizations, levels of care, and appeals.

● Provide discharge referrals as needed to facilities. Provide discharge information to insurance.

● Advocate on the patient’s behalf to ensure services will be covered by insurance company

● Ability to adhere to HIPPA compliance standards

● Ability to articulate medical necessity using medical dialect

● Proficient in personal time management, multi-tasking and calendar organization

● Complete new admissions and concurrent reviews in a timely manner

● Review clinical information and communicate documentation needs

● Establish and maintain professional relationships with care managers Qualifications and Skills

● Minimum of 5-8 years experience in the Utilization Review process

● Minimum of 2 years in Substance Abuse/Mental Health Treatment

● Extensive knowledge of Substance Abuse/Addictions treatment; ASAM, and Medical Necessity criteria

● Experience working in clinical appeals in the UR environment

● Ability to successfully navigate private insurance requirements for proper submission of appeal

● Effective communication skills, both verbal and written via phone and email

● Proficiency utilizing related software programs such as Kipu, ZenCharts, BestNotes, SunWave etc.

● Proficiency in Google Products including Google Workspace, Google Drive, Google Sheets, Google Docs

● Ability to navigate various technology and software tools

● Excellent organizational skills

Education and Experience

● Bachelor’s degree or higher in Psychology or related field (Preferred)

● 5-8 years of experience conducting utilization reviews in healthcare/billing company settings.

● 2 years of experience working in mental health or behavioral healthcare setting

(Preferred):

● Licensed Mental Health Clinician (LCSW, LMHC, LMFT)

● Certified Addiction Counselor or Professional (CAC, CAP, MCAP, MAC)

● Experience working in a behavioral health billing setting

● Experience working in Substance Abuse/Mental Health Treatment Industry

● Experience managing caseloads of 40+ per week

● Experience obtaining an average of 200 authorizations per month

● Knowledge in day-to-day operations of a psychiatric or behavioral healthcare setting

● Comprehensive knowledge of all levels of care (Detox, RTC, PHP, IOP, OP, Aftercare)

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