Exact Billing Solutions is a team of revenue cycle management professionals specializing in substance use disorder, mental health, and autism care fields.
As a Medical Records Reviewer, your role is to review and process records for authorization submission to payors, collaborating with clinical teams, insurance providers, and healthcare professionals to support effective patient care.
Responsibilities include reviewing and analyzing clinical records for compliance with ABA therapy and insurance requirements, maintaining records and authorization requests in electronic health record systems, tracking documentation for utilization reviews, monitoring pending authorizations and treatment plan updates, verifying documentation for treatment authorization, assessing healthcare service appropriateness, coordinating with interdisciplinary teams including Board Certified Behavior Analysts and Registered Behavior Technicians, preparing records for audits and insurance reviews, identifying documentation discrepancies, coordinating with insurance providers for authorizations and denials resolution, analyzing trends in authorization requests and denials to provide management insights, and participating in quality improvement initiatives.
Associate's or Bachelor's degree in Healthcare Administration, Medical Records, Behavioral Health, or related field.
Certification in Health Information Management (e.g., RHIA, RHIT) is a plus but not required.
Minimum of 1 year experience in clinical records, medical documentation, or utilization review, preferably in ABA therapy, behavioral health, or healthcare.
Experience in utilization review or related field with strong understanding of healthcare service delivery and documentation.
Clean background, drug screenings, and driving record.
Strong familiarity with industry standards for utilization review, ability to analyze complex medical documentation, strong critical thinking and analytical skills, excellent communication and interpersonal skills.
21 paid days off (15 days PTO increasing with tenure, plus 6 holidays).
Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
Medical, dental, vision, long-term disability, and life insurance.
Generous 401(k) with up to 6% employer match.
Location
Florida, US
Employment Type
Full-time
Experience Level
Associate
Salary Range
$55,000 - $70,000
Remote work allowed
No
Posted
1 month ago