MMBS LLC dba/Aftermath Billing is hiring: Utilization Review Specialist - Behavi

Utilization Review Specialist
Remote, Full-Time
Specializing in Behavioral Health and Substance Abuse

About Us
We are a medical billing company dedicated to providing expert billing support in the behavioral and substance abuse fields. Our mission is to ensure our clients receive seamless, high-quality services that allow their clinical teams to focus on patient care. We’re seeking a Utilization Review (UR) Specialist with strong knowledge in behavioral health and substance abuse to join our fully remote team.

Position Overview
The Utilization Review Specialist is a critical role in our billing process, overseeing the pre-certification and medical documentation needed for continued insurance authorization. Once a new client is admitted, our admissions coordinator inputs their information into our system, prompting the UR Specialist to gather necessary pre-certification and documentation. This role requires a proactive, detail-oriented individual skilled in communicating with case managers and securing authorizations that optimize patient care and reimbursement.

Key Responsibilities

• Review clinical documentation and medical records to confirm medical necessity criteria, specifically within behavioral health and substance abuse settings.
• Coordinate with clinical and medical staff to compile and submit documentation for insurance authorizations.
• Conduct pre-certification, concurrent, and retrospective reviews, including appeals when necessary.
• Liaise with insurance providers to secure the highest level of care and coverage for clients, utilizing ASAM, DSM V, and other recognized guidelines.
• Manage a caseload of 15-20 cases across multiple facilities, maintaining timely and accurate records in Kipu, Sunwave, and Collaborate MD systems as applicable.
• Advocate for continued patient care by conducting regular reviews of patient progress and negotiating with insurers to extend benefits when medically justified.

Qualifications

• Minimum of 2 years of experience in utilization review within behavioral health and substance abuse.
• Proven track record of UR success and familiarity with the admissions process for rehab or detox facilities.
• Strong knowledge of ASAM, DSM V, ICD-9/10; prior experience with Kipu, Sunwave, and Collaborate MD preferred.
• Familiarity with handling cases across multiple facilities and clients in a remote setting.
• Preferred candidates are based in Florida, though applicants from other regions will also be considered.

Why Join Us?
We recognize the value our team brings, and we offer an exceptional compensation package, including:

• Competitive salary with company-sponsored healthcare (medical, dental, vision), short and long-term disability, and life insurance.
• Additional benefits such as gap coverage and optional supplemental insurance.

If you’re passionate about ensuring high standards of care in behavioral health and substance abuse and excel in a fast-paced, fully remote environment, we encourage you to apply!