Utilization Review Specialist

Utilization Review Coordinator Company:

Lotus Billing Location:

Boca Raton, FL (On-site preferred; remote considered for the right candidate)

Pay:

$50,000-$75,000 annually, depending on experience

Job Type:

Full-time About Us Lotus Billing is a specialized revenue cycle management partner serving substance use disorder (SUD) and behavioral health treatment providers. We work closely with our client facilities to ensure authorizations are secured, maintained, and communicated effectively so that care is never interrupted and claims are never left on the table. Position Summary We're looking for a detail-oriented Utilization Review Coordinator to manage the authorization process for SUD and behavioral health treatment services. You'll work directly with insurance payers to obtain and maintain authorizations across all levels of care, coordinate with clinical teams on concurrent reviews, and help ensure continuity of coverage for patients. We're open to candidates at all experience levels — if you're organized, persistent, and comfortable navigating insurance processes, we want to hear from you. Key Responsibilities Obtain prior authorizations and concurrent reviews for PHP, IOP, and OP levels of care Communicate with insurance payers by phone and portal to initiate, track, and follow up on authorizations Coordinate with clinical staff to gather and submit medical necessity documentation and clinical updates Monitor authorization timelines and proactively request extensions to avoid gaps in coverage Document all authorization activity accurately in KIPU and internal tracking systems Identify and escalate denial trends or payer issues to the billing and collections teams Maintain working knowledge of payer-specific criteria and level-of-care requirements Support appeals when authorizations are denied, in coordination with the collections team Qualifications High school diploma or equivalent; associate's or bachelor's a plus Experience in utilization review, insurance authorization, or behavioral health billing preferred — but we'll train the right person Familiarity with SUD/behavioral health levels of care (detox, residential, PHP, IOP, OP) is a strong plus Knowledge of ASAM criteria and medical necessity standards a plus Experience with KIPU, Availity, or payer portals preferred Strong organizational skills and attention to detail — you're managing timelines that directly affect patient care Clear, professional communication skills — you'll be on the phone with insurance companies daily Comfortable working independently and managing a caseload Compensation & Benefits $50,000-$80,000 annually, based on experience Health insurance: 60% employer-paid, up to $600/month 3 weeks total paid time off annually (2 weeks vacation + 1 week sick) To Apply Submit your resume through Indeed.

Pay:

$50,000.00 - $75,000.00 per year

Benefits:

Health insurance Paid time off

Experience:

Utilization review: 1 year (Preferred)

Work Location:

In person