Current jobs related to Utilization Review Specialist - India - Saanzz Digital
-
Medical Review Specialist
4 weeks ago
India The Legal Base Full timeJob Title: Medical Review Specialist Company: The Legal Base About Us : The Legal Base is a dynamic and forward-thinking ALSP (Alternate Legal Service Provider) dedicated to providing exceptional legal outsourced services to our US and Canada based clients. We are seeking a detail-oriented and experienced Medical Review Specialist to join our team. Job...
-
Medical Review Specialist
4 weeks ago
india The Legal Base Full timeJob Title: Medical Review SpecialistCompany: The Legal BaseAbout Us: The Legal Base is a dynamic and forward-thinking ALSP (Alternate Legal Service Provider) dedicated to providing exceptional legal outsourced services to our US and Canada based clients. We are seeking a detail-oriented and experienced Medical Review Specialist to join our team.Job Summary:...
-
Medical Review Specialist
4 weeks ago
India The Legal Base Full timeJob Title: Medical Review SpecialistCompany: The Legal BaseAbout Us: The Legal Base is a dynamic and forward-thinking ALSP (Alternate Legal Service Provider) dedicated to providing exceptional legal outsourced services to our US and Canada based clients. We are seeking a detail-oriented and experienced Medical Review Specialist to join our team.Job Summary:...
-
Utilities Solution Architect
5 months ago
India NodeFlair Full time**Job Summary**: **Job Type** **Seniority** **Years of Experience** Information not provided **Tech Stacks** Strategy Oracle Position Summary: CC&B Architect would provide leadership and guidance in defining the CCB, C2M solution landscape and strategy. This position would be responsible for design and solutioning for new Billing Projects using Oracle...
-
SAP Utilities Functional Consultant
2 days ago
Anywhere in India/Multiple Locations ANLAGE Full time**Job Summary**We are seeking an experienced SAP CRM Utilities Specialist to join our team at ANLAGE. The ideal candidate will have a strong background in SAP CRM and Utilities, with a proven track record of delivering successful projects.Key Responsibilities:Design, build, and configure SAP CRM Utilities to meet business requirements.Collaborate with...
-
Oracle Utilities WAM Specialist
3 weeks ago
Anywhere in India/Multiple Locations Jwalpa Tech Services Full timeJob Title: Oracle Utilities WAM TesterJob Summary:We are seeking a highly skilled Oracle Utilities Work And Asset Management (WAM) Tester to join our team at Jwalpa Tech Services. As a WAM Tester, you will be responsible for testing and validating the functionality of our Oracle Utilities WAM system.Key Responsibilities:Working experience with OUTA (Oracle...
-
Oracle Utilities WAM Specialist
3 weeks ago
Anywhere in India/Multiple Locations Jwalpa Tech Services Full timeJob Title: Oracle Utilities WAM TesterJob Summary:We are seeking a highly skilled Oracle Utilities WAM Tester to join our team at Jwalpa Tech Services. The successful candidate will be responsible for testing and validating the functionality of Oracle Utilities Work and Asset Management (WAM) software.Key Responsibilities:Working experience with OUTA (Oracle...
-
Medical, legal and regulatory reviewer(mlr)
3 weeks ago
India Theron Solutions Full timeJob Insights: The Medical, Legal and Regulatory (MLR) review is an essential process in healthcare marketing to make sure advertising, promotional and non-promotional content is accurate, compliant, and ready to be published. The MLR process must rigorously control and execute review, approval and document filing actions. Responsibilities: Manages the...
-
Medical, Legal and Regulatory Reviewer(MLR)
2 months ago
India Theron Solutions Full timeJob Insights:The Medical, Legal and Regulatory (MLR) review is an essential process in healthcare marketing to make sure advertising, promotional and non-promotional content is accurate, compliant, and ready to be published. The MLR process must rigorously control and execute review, approval and document filing actions.Responsibilities:Manages the...
-
Oracle Utilities WAM Specialist
2 weeks ago
Anywhere in India/Multiple Locations Jwalpa Tech Services Full timeJob Description & Responsibilities :1. Proficient in Oracle Utilities Work And Asset Management with strong understanding of software testing principles and methodologies. 2. Experience with test automation tools such as Selenium or Appium and knowledge of programming languages like Java or Python. 3. Familiarity with Agile development methodologies and good...
-
Referral Authorization Specialist
6 minutes ago
india Regal Outsource (India) Private Limited Full timeSummary: A Referral Authorization Specialist oversees both patient referrals and authorization processes in a healthcare setting. Key responsibilities include obtaining pre-authorizations from insurance companies, managing referral documentation, and ensuring that patients are scheduled appropriately with specialists or for diagnostic services. They...
-
Data Specialist
3 weeks ago
india WebBuddy Full timeCompany Description At WebBuddy, we are a web design and development agency committed to being a trusted partner in shaping online presence. Our team of expert developers, creative designers, and strategic thinkers strive to transform ideas into digital realities for clients globally. With a focus on delivering top-notch, customized web solutions that drive...
-
Data Specialist
2 weeks ago
India WebBuddy Full timeCompany Description At WebBuddy, we are a web design and development agency committed to being a trusted partner in shaping online presence. Our team of expert developers, creative designers, and strategic thinkers strive to transform ideas into digital realities for clients globally. With a focus on delivering top-notch, customized web solutions that...
-
Data specialist
2 weeks ago
India WebBuddy Full timeCompany Description At Web Buddy, we are a web design and development agency committed to being a trusted partner in shaping online presence. Our team of expert developers, creative designers, and strategic thinkers strive to transform ideas into digital realities for clients globally. With a focus on delivering top-notch, customized web solutions that...
-
Virtual reality development specialist
14 hours ago
India VB Group® Full timeCompany Description VB® Group is a global leader in innovation and transformation, offering cutting-edge solutions across various industries. With a focus on digital transformation and technological advancement, VB® Group empowers businesses worldwide to navigate complex challenges in the digital age. The company's flagship products, Wis Twin and 360...
-
Design Specialist
2 weeks ago
India We Launch Full timeJob Title : Design Specialist (Full-Time, Remote) Company: WeLaunch Company Description: WeLaunch is a specialized agency dedicated to accelerating the growth of B2B and SaaS startups. Our team excels in lead generation through tactics like LinkedIn outbound messaging and email marketing. We craft effective marketing strategies, create engaging...
-
Design specialist
2 weeks ago
India We Launch Full timeJob Title : Design Specialist (Full-Time, Remote) Company: We Launch Company Description: We Launch is a specialized agency dedicated to accelerating the growth of B2 B and Saa S startups. Our team excels in lead generation through tactics like Linked In outbound messaging and email marketing. We craft effective marketing strategies, create...
-
Data Specialist
3 weeks ago
India WebBuddy Full timeCompany Description At WebBuddy, we are a web design and development agency committed to being a trusted partner in shaping online presence. Our team of expert developers, creative designers, and strategic thinkers strive to transform ideas into digital realities for clients globally. With a focus on delivering top-notch, customized web solutions that drive...
-
Data Specialist
2 weeks ago
India WebBuddy Full timeCompany Description At WebBuddy, we are a web design and development agency committed to being a trusted partner in shaping online presence. Our team of expert developers, creative designers, and strategic thinkers strive to transform ideas into digital realities for clients globally. With a focus on delivering top-notch, customized web solutions that drive...
-
Virtual Reality Development Specialist
2 days ago
India VB Group® Full timeCompany Description VB® Group is a global leader in innovation and transformation, offering cutting-edge solutions across various industries. With a focus on digital transformation and technological advancement, VB® Group empowers businesses worldwide to navigate complex challenges in the digital age. The company's flagship products, WisTwin and 360Vista...
Utilization Review Specialist
2 months ago
Saanzz Digital is currently hiring a UR Specialist for one of its clients named Zealie based in the US.
About Zealie
Zealie is a fast-growing Medical Billing Services company specializing in the Behavioral Healthcare industry. Zealie's service clients are substance use disorder treatment, addiction recovery, and mental health treatment centers that are saving lives on a daily basis.
Zealie's state of the art proprietary technology provides data analytics and revenue prediction tools to its clients to help them make strategic business decisions to grow their business.
Job Summary
The UR Specialist plays a crucial role in obtaining authorizations by performing a variety of functions including but not limited to, navigating electronic medical records and advocating for the patient; communicating with insurance carriers via phone, fax, and web portals as needed and articulating medical necessities using specialized language while strictly adhering to compliance standards.
Following Zealie’s UR process, the UR Specialist is responsible for the upkeep of all authorization notes, their days authorized, and next review dates . They assess continued treatment for clients that do not require authorization, and contact the facilities for more information as needed.
Responsibilities and Duties:
● Communicate with facilities assigned to you in order to obtain authorizations.
● Follow Zealie’s UR process to document the dates and times contact was made to facilitate authorization.
● Understand and communicate the verification of benefits to the facility if the need arises.
● Understand the retro authorization and appeal process.
● Facilitate and undertake peer reviews, or peer review scheduling.
● Collaborate with facility treatment teams, to manage the clients level of care.
● Understand medical necessity as it pertains to insurance authorizations, levels of care, and appeals.
● Provide discharge referrals as needed to facilities. Provide discharge information to insurance.
● Advocate on the patient’s behalf to ensure services will be covered by insurance company
● Ability to adhere to HIPPA compliance standards
● Ability to articulate medical necessity using medical dialect
● Proficient in personal time management, multi-tasking and calendar organization
● Complete new admissions and concurrent reviews in a timely manner
● Review clinical information and communicate documentation needs
● Establish and maintain professional relationships with care managers Qualifications and Skills
● Minimum of 5-8 years experience in the Utilization Review process
● Minimum of 2 years in Substance Abuse/Mental Health Treatment
● Extensive knowledge of Substance Abuse/Addictions treatment; ASAM, and Medical Necessity criteria
● Experience working in clinical appeals in the UR environment
● Ability to successfully navigate private insurance requirements for proper submission of appeal
● Effective communication skills, both verbal and written via phone and email
● Proficiency utilizing related software programs such as Kipu, ZenCharts, BestNotes, SunWave etc.
● Proficiency in Google Products including Google Workspace, Google Drive, Google Sheets, Google Docs
● Ability to navigate various technology and software tools
● Excellent organizational skills
Education and Experience
● Bachelor’s degree or higher in Psychology or related field (Preferred)
● 5-8 years of experience conducting utilization reviews in healthcare/billing company settings.
● 2 years of experience working in mental health or behavioral healthcare setting
(Preferred):
● Licensed Mental Health Clinician (LCSW, LMHC, LMFT)
● Certified Addiction Counselor or Professional (CAC, CAP, MCAP, MAC)
● Experience working in a behavioral health billing setting
● Experience working in Substance Abuse/Mental Health Treatment Industry
● Experience managing caseloads of 40+ per week
● Experience obtaining an average of 200 authorizations per month
● Knowledge in day-to-day operations of a psychiatric or behavioral healthcare setting
- ● Comprehensive knowledge of all levels of care (Detox, RTC, PHP, IOP, OP, Aftercare)
