Find & Apply For Clinical Auditor / Utilization Reviewer Jobs in Galax, Virginia

Job Overview The Utilization Review Coordinator is responsible for managing the utilization review process to ensure timely authorization and continued coverage of services provided to patients. This role serves as a liaison between clinical staff and insurance companies by preparing and submitting authorization requests, obtaining required clinical documentation and signatures, tracking insurance determinations, and monitoring coverage timelines. The coordinator plays a critical role in maintaining reimbursement by ensuring all reviews, authorizations, and documentation are completed accurately and within required deadlines. Essential Duties and Responsibilities Prepare and complete all Authorization Request (ART) forms and other utilization review documentation required by insurance providers. Coordinate with clinicians to obtain necessary clinical information, supporting documentation, and signatures for authorization submissions. Review documentation for completeness, accuracy, and compliance with payer requirements before submission. Submit authorization requests, concurrent reviews, and continued stay reviews to insurance companies within required timeframes. Follow up with insurance representatives regarding pending authorizations and review determinations. Serve as the primary point of contact between the facility and insurance companies regarding utilization reviews and authorizations. Monitor and maintain records of approved days, last covered days (LCDs), and authorization periods for all patients. Track due dates for concurrent reviews and reauthorization requests to prevent lapses in coverage. Ensure all utilization review activities are documented accurately in the EHR and applicable tracking systems. Collaborate closely with clinical staff, admissions, billing, and case management teams. Required Qualifications High school diploma or equivalent required; Associate's or Bachelor's degree preferred. Minimum of one (1) year of Utilization Review experience required, preferably in behavioral health, substance use disorder treatment, or a related healthcare setting. Working knowledge and understanding of the ASAM (American Society of Addiction Medicine) Criteria. Understanding of ASAM terminology and levels of care, including the ability to apply ASAM criteria when communicating with insurance providers and reviewing clinical documentation. Strong clinical knowledge and understanding of medical necessity criteria, treatment planning, and documentation requirements. Knowledge of insurance authorization processes, concurrent reviews, and payer requirements. Experience working with electronic health records (EHRs) and healthcare management systems. Strong organizational skills with the ability to manage multiple deadlines and review schedules simultaneously. Excellent written, verbal, and interpersonal communication skills. Proficiency in Microsoft Office Suite and utilization management tracking systems. Ability to maintain confidentiality and comply with HIPAA regulations

Pay:

$19.00 - $20.00 per hour

Benefits:

401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

Hybrid remote in Galax, VA 24333