ESSENTIAL DUTIES AND RESPONSIBILITIES

- Conduct comprehensive utilization review activities for behavioral health services, ensure adherence to payer guidelines, medical necessity criteria, and regulatory requirements.

- Review and analyze clinical documentation, treatment plans, and patient records

- Collaborate with therapists, physicians and other clinical staff to obtain required information and ensure seamless continuity of care.

- Good understanding with EMR systems ifor documentation review, tracking, and utilization management.

- Manage prior authorizations through payer portals.

- Verify referrals/authorizations for denied procedures. Obtain and work with the practice to correct any referrals/authorizations for denied procedures.

- Checking insurance eligibility and advantages for patients, as needed.

- Reviewing patient accounts for accuracy and completeness and obtaining any missing information.

- Ensure accurate submissions, benefit verification, timely follow-ups, and successful approvals.

- Following up on unpaid claims within standard billing cycle timeframe for the client and carrier.

- Checking each insurance payment for accuracy and compliance with contract discount, as necessary.

- Calling insurance companies regarding any discrepancy in payments if necessary

- Identifying and billing secondary or tertiary insurances.

- Reviewing accounts for insurance of patient follow-up including review and research of self-pay, refund accounts for insurance.

- Researching and appealing denied claims.



Coding research appeals and corrections at the discretion of the client and management.

- Answering patient or insurance telephone inquiries pertaining to assigned accounts.

- Understand CPT codes and ICD-10 codes and when these can be changed or not.

- Understand the insurance carriers requirements for submitting claims and appeals.

- Understand special situations and procedures that relate to the specialty you work on.

- Performs other duties as assigned.

MINIMUM JOB REQUIREMENTS

Education, Training, and Experience Required:

- Bachelors Degree or a 3 year Diploma or equivalent is required.

- Two (2) years of medical billing AR Calling/Analysis experience is required. Two (2) years of UR experience is preferred

- Willing to work night shifts as per US time zones

Knowledge/Skills/Abilities:

- Excellent interpersonal skills.

- Solid computer/technology skills.

- Excellent ability to analyze problems and select proper resolution.

- Excellent written and oral communication skills.

- Excellent ability to organize tasks and work independently.

- Ability to multi-task.

- Effectively implement and manage assigned programs and functions.

- Establish and maintain effective working relationships with individuals at all levels of the organization.

- Ability to communicate effectively and clearly with people from diverse backgrounds.

- Ability to competently use Microsoft Office, including Word, Outlook, Excel, and appropriate practice management software.

Perks and Benefits

As per market standards

📌 UR - Utilization Review Specialist (Bengaluru)
🏢 Avc Informatics
📍 Bengaluru