Utilization Review Specialist

Description
Utilization Review Specialist - Exact Billing Solutions
Lauderdale Lakes, FL
About Exact Billing Solutions
Exact Billing Solutions is a unique team of medical billing professionals specializing in the substance use disorder, mental health, and autism fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies.
Growth Opportunity in Cutting-Edge Medical Billing
If you're an experienced clinician looking to forge a new career path where your clinical knowledge is valued, consider our Utilization Review Specialist position.
As a Utilization Review Specialist, you will play a pivotal role in ensuring the efficient and effective utilization of healthcare resources. You will be responsible for reviewing and evaluating clinical documentation, treatment plans, and medical records to optimize patient care and streamline healthcare delivery processes.
What You Will Do
Clinical Documentation Review:
Evaluate and analyze medical records, treatment plans, and clinical documentation to ensure accuracy and compliance with established standards.
Collaborate with healthcare providers to gather additional information or clarification on documentation when necessary.
Utilization Review:

Assess the appropriateness and necessity of healthcare services, ensuring they align with established guidelines and policies.
Identify and communicate potential issues related to overutilization or underutilization of services.
Collaboration and Communication:

Work closely with interdisciplinary teams, Board Certified Behavior Analysts, Registered Behavior Technicians, and other healthcare professionals to gather insights and ensure comprehensive reviews.
Communicate findings and recommendations clearly and effectively to internal teams and external stakeholders.
Quality Improvement:

Participate in quality-improvement initiatives to enhance the overall efficiency and effectiveness of healthcare delivery.
Provide feedback and suggestions for process improvements based on review findings.
Regulatory Compliance:

Stay informed on relevant healthcare regulations, guidelines, and accreditation standards.
Ensure compliance with all applicable laws and regulations in the utilization review process.
Requirements
Education/Experience and Other Requirements

Proven experience in utilization review or a related field with a strong understanding of healthcare service delivery and documentation processes is highly desirable.
Up-to-date knowledge of relevant healthcare regulations, guidelines, and accreditation standards.
Understanding of compliance requirements and the ability to ensure adherence during the utilization review process.
Must maintain clean background/drug screenings and driving record.
Expertise Needed

Familiarity with industry standards, guidelines, and best practices related to utilization review.
Ability to analyze complex clinical documentation, treatment plans, and medical records.
Strong critical thinking skills to assess the appropriateness and necessity of healthcare services.
Excellent communication and interpersonal skills.
Ability to work collaboratively in a team-oriented environment.