Find & Apply For Clinical Analyst / Clinical Documentation and Improvement Specialist Jobs in Marion, Ohio

Job Overview We are seeking a dedicated and detail-oriented Utilization Specialist to join our dynamic behavioral health team. In this vital role, you will be responsible for managing the utilization review process, ensuring that patient care is delivered efficiently and in accordance with insurance policies and clinical guidelines. Your expertise will help optimize resource use, facilitate insurance approvals, and support clinical teams in delivering high-quality care. This position offers an exciting opportunity to contribute to patient outcomes while maintaining compliance with healthcare regulations and policies. Duties Review patient records and clinical documentation to determine medical necessity based on established criteria such as

ICD-9, ICD-10, CPT

coding, and medical billing standards Coordinate with healthcare providers to obtain additional information or clarification needed for utilization review and insurance prior authorization requests Verify insurance coverage, benefits, and policy details in electronic health records (EHR) systems and manage insurance verification processes Ensure compliance with HIPAA regulations and clinical confidentiality policies during all review activities Collaborate with managed care organizations to facilitate authorization approvals and resolve any coverage issues promptly Maintain accurate documentation of all utilization review activities within medical records and EHR systems Stay current on health insurance policies, coding updates, and industry best practices related to medical coding, billing, and insurance requirements Skills Strong knowledge of HIPAA regulations, clinical confidentiality policies, and health insurance privacy standards Proficiency in CPT coding, ICD-9, ICD-10, ICD coding systems, and medical terminology Experience with electronic health records (EHR) management and Microsoft Office applications for documentation and reporting Familiarity with insurance prior authorization procedures, and health insurance policy details Excellent customer service skills to communicate effectively with healthcare providers, insurers, and patients Ability to interpret medical records accurately for utilization review purposes Knowledge of medical billing procedures, insurance verification processes, and healthcare compliance standards Must have experience with behavioral health prior authorization processes Join us as a Utilization Specialist to make a meaningful impact on patient care through meticulous resource management and seamless collaboration with healthcare professionals. Your expertise will help ensure efficient care delivery while adhering to industry standards and regulations.

Benefits:

Dental insurance Health insurance Health savings account Life insurance Paid time off Referral program Tuition reimbursement Vision insurance People with a criminal record are encouraged to apply

Work Location:

In person