THE PERKS FOOSBALL TABLE JUICE BAR AIR HOCKEY IN-OFFICE MASSAGES We also offer a team discount program for electronics, cell phones, dining, travel expenses and more. We have a work hard, play hard mentality and believe that the office should be a fun place to spend time. THE WORK ENVIRONMENT In order to maintain a healthy, vital work environment, it is essential for our team to be able to provide us with lots of feedback, whether it be how to improve our processes or which pinball machine we should get next. We value the opinion of our team members and do our best to make their suggestions a reality. Your voice matters at Spotlight Billing. THE BENEFITS We know we wouldn’t be here if it wasn’t for our team, and it’s important that they know it too. We provide an excellent compensation package which includes competitive salary, company sponsored top-notch healthcare and life insurance policy. Our team members can elect dental, vision, and supplemental insurance benefits. UTILIZATION REVIEW SPECIALIST Interested applicants should send their resume, cover letter to: susan unruh Director of Human Relations [email protected] The Utilization Review proactively monitors and assesses clinical documentation and medical records to ensure that medical necessity criteria are met for each level of care. Coordinates with the medical and clinical staff to prepare documentations to present to insurance companies for continued authorization. The focus of our UR Specialist is to manage the review and approval process allowing the clients clinical and medical staff time to a focus on providing the highest level of care for their clients. Essential Functions: Performs clinical review for medical necessity for Facility/Member/Provider using evidenced based guidelines, policies, benefits and nationally recognized clinical criteria Conducts pre-certification reviews and appeals reviews Peer to Peer reviews with Conducts retrospective clinical review of claims for medical necessity, coding accuracy, medical policy compliance and contract compliance Negotiate with insurance companies to achieve the highest level of care for patients / clients based upon ASAM and other approved criteria Conduct continuous reviews of patient progress advocating for continued client care at the maximum length of care with the highest level of benefits. Qualifications: Master Level / Licensed Clinicians or RN/LPN with proven track record in Behavioral Health and Substance Abuse Knowledge of ASAM / DSM V / ICD-9, 10 Knowledge of Electronic Medical Records and Billing systems