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Utilization Review Coordinator

Company:
Council on Alcoholism and Drug Abuse Northwest Louisiana
Location:
United States
Posted:
November 14, 2016
Description:

Summary of Position Responsibilities: The Utilization Review Coordinator position coordinates, manages, and monitors third party payments for CADA services. In addition, the Utilization Review Coordinator develops implements and monitors new systems relating to utilization review.

Qualifications:

Associate or bachelor degree in related field

Documented experience in utilization review-2 years preferred

Communication and writing skills

Familiarity with the operation of non-profit organizations is preferred

Essential Duties:

Maintain awareness of health insurance changes

Prepare documents to obtain treatment provider status from third party payers

Conduct credentialing and re-credentialing procedures required by Medicaid/commercial insurance companies

Prepare for and conduct Medicaid/commercial insurance company sight surveys at CADA facilities

Negotiate reimbursement rates with third party payers

Creates processes and policies to manage and make positive improvements to insurance claims procedures

Analyze insurance, government and accrediting agency standards to determine the review criteria for facility processes including admissions, treatment and length of client visit

Coordinate peer to peer reviews

Provide applicable training to financial staff members

Coordinate payment for client services with the CADA billing specialist

Oversee the paperwork process in working with third party payers and document all contact, conversations and payment requests

Train personnel in the use of new forms, reports, and procedures related to utilization review