Utilization Review Specialist (Behavioral Health – Data Entry Focus)

Job Type: Full-Time Department: Clinical Operations / Utilization Management Reports To: Utilization Review Manager Position Summary: We are seeking a detail-oriented and highly organized Utilization Review (UR) Specialist to join our Behavioral Health team. The ideal candidate will be responsible for supporting clinical decision-making and utilization management processes through meticulous data entry, documentation review, and coordination with internal and external stakeholders. This role plays a vital part in ensuring timely and accurate authorization and review of behavioral health services while maintaining compliance with payer and regulatory requirements.

Key Responsibilities: 1. Utilization Review Coordination • Review patient clinical documentation to determine medical necessity for behavioral health services. • Collaborate with clinicians to gather additional information when required. • Submit timely authorization requests to insurance companies or third-party administrators. 2. Data Entry & Documentation • Accurately enter clinical data, patient information, and authorization outcomes into electronic health records (EHR) and UR tracking systems. • Maintain up-to-date logs of all utilization review activities, including approval/denial status, payer communications, and relevant deadlines.

• Perform quality checks to ensure data accuracy, completeness, and compliance with organizational standards. 3. Insurance & Compliance Communication • Interface with insurance providers to verify benefits, submit clinical reviews, and follow up on authorizations. • Ensure compliance with HIPAA, state, and federal regulations governing behavioral health and UR processes. 4. Reporting & Audit Support • Assist in generating weekly and monthly reports related to authorization volumes, turnaround times, and denial trends.

• Support audit requests by compiling required documentation and logs. Required

Qualifications: • High School Diploma or GED required; Associate’s or Bachelor’s degree in Psychology, Health Sciences, or related field preferred. • 1–2 years of experience in utilization review, medical billing, insurance authorization, or behavioral health services. • Proficient in data entry with strong attention to detail (minimum 50 WPM preferred). • Experience working with EHR systems (e.g., CareLogic, Credible, Epic, etc.).

• Knowledge of insurance processes, including Medicaid, Medicare, and commercial payers. • Strong organizational and time management skills with the ability to manage multiple priorities. Preferred Skills & Competencies: • Familiarity with DSM-5 diagnostic criteria and behavioral health terminology. • Ability to read and understand clinical documentation such as treatment plans and progress notes. • Proficient in bolthires Office Suite (Excel, Word, Outlook). • Team-oriented mindset with effective written and verbal communication skills.

• Capable of working in a fast-paced, deadline-driven environment. Work Environment: • Standard office setting or remote work, depending on location. • Regular use of computer and telephone systems. • May require flexible scheduling to meet urgent utilization review timelines. Why Join Us? • Meaningful work that directly impacts client care and outcomes. • A supportive team culture with opportunities for growth and development. • Competitive compensation and benefits package. Apply tot his job

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