Utilization Review Specialist

2 weeks ago

Toronto, Ontario, Canada Embark Behavioral Health Full time

Job Summary:

We are seeking a detail-oriented and organized Utilization Review Specialist to join our team at Embark Behavioral Health. As a key member of our Utilization Review Department, you will be responsible for ensuring timely insurance authorizations, effective communication with clients and providers, and maintaining documentation standards.

Key Responsibilities:

  • Collaborate with the Utilization Review Supervisor to achieve department objectives and drive process improvements
  • Ensure clients receive necessary certifications for services and maintain accurate documentation
  • Communicate effectively with clients, providers, and billing department to resolve issues and address concerns
  • Monitor documentation requirements and recommend process enhancements to improve efficiency and quality
  • Assist in education for treatment team providers on documentation standards and best practices
  • Interface with managed care organizations and payors to resolve authorization and payment issues
  • Complete pre-authorizations and retrospective review requests in a timely and accurate manner
  • Manage medical records requests and other assigned duties to ensure seamless operations

Requirements:

  • Previous customer service experience with a focus on healthcare or insurance
  • Knowledge of insurance utilization review and medical terminology, including HIPAA guidelines
  • Strong communication and negotiation skills to effectively interact with clients, providers, and payors
  • Ability to maintain confidentiality and handle sensitive information with discretion
  • Proficiency in Windows-based applications and MS Excel to manage data and reports

Benefits:

  • Comprehensive Benefits Program including medical, dental, and vision insurance
  • 401K with company matching and paid parental leave
  • Company Paid Holidays and PTO accrual schedule

About Embark Behavioral Health:

Embark Behavioral Health is a leading provider of behavioral health services, dedicated to delivering high-quality care and support to individuals and families. Our team is passionate about making a meaningful difference in the lives of those we serve, and we are committed to creating a supportive and inclusive work environment.

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