Payment Recovery Specialist is responsible for analysis of denied reimbursement claims. Ensures appropriate insurance coverage for compliance standards and revenue generation. Being a Payment Recovery Specialist monitors, evaluates, and reviews all cost reporting in support of claims. Coordinates with departments and insurance companies to correct errors as necessary. Additionally, Payment Recovery Specialist requires a bachelor's degree in area of specialty. Typically reports to a supervisor or manager. To be a Payment Recovery Specialist typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)
The Utilization Review Specialist is responsible for organizing and conducting concurrent reviews with all insurance carriers. Daily task are (but not limited to): Conducting prior authorizations and continued stay reviews with insurances while utilizing ASAM criteria to determine medical necessity for each level of care in time allotted. UR Specialist will work closely with clinical teams and medical staff to minimize denials and facilitate optimal use of facility resources.
Requirements:
Skills, knowledge, and abilities required:
Qualifications
The Utilization Review Specialist will Collaborate with BriteLife facilities regarding Utilization Review (UR) and ensures that all clients are authorized for treatment at the appropriate level of care in a timely manner. The UR Specialist serves a dual function ensuring quality and comprehensive charting of all services rendered by maintaining collaborative lines of communication with facility leadership.
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