Ur Specialist
CurrentSUD/MH Billing & Management UR SpecialistManagement of multiple facilities and policies to ensure medical necessity, medical records are up to date, and maximum lengths of stay.Duties include but are not limited to: • Responsible for reviewing clinical for primary MH and SUD facility preauthorization requests.• Conducted clinical reviews – live, fax, and web portal – to advocate medical necessity.• Scheduled and completed peer reviews and appeals for denial.• Advocated for SCA and INE requests.• Completed both step-down and step-up requests for HLOC, LLOC.• Responsible for reviewing clinical and medical information for precertification, concurrent, and step- down LOC SUD with adherence to ASAM criteria.• Spoke with insurance agents regarding ICD-10, diagnosis codes.• Familiar with JCAHO and CARF guidelines/policies.• Compliance with established UR review process performance expectations and standards, assuring clients receive the highest degree of medical care and length of stay.