Pro Med Healthcare Services

Role Description The UR Specialist is responsible for reviewing clinical documentation to ensure medical necessity, appropriate level of care, and compliance with payer and regulatory requirements. This role works closely with clinical staff, admissions, and insurance providers to support timely authorizations, continued stay reviews, and quality patient care. - Review patient records to verify medical necessity and appropriateness of services. - Conduct initial and concurrent reviews with insurance companies to obtain authorizations. - Prepare and submit clinical documentation for continued stay requests. - Track authorization status and maintain accurate documentation in the medical record. - Communicate effectively with clinical teams to obtain required information. - Assist with denial management and appeals as needed. - Ensure compliance with state, federal, and accreditation requirements (e.g., CARF, AHCA, DCF, etc.). - Maintain confidentiality of all patient and organizational information. Qualifications - Bachelor’s degree in Mental Health, Social Work, Psychology, or related field (or equivalent experience). - 2 years of previous experience in utilization review or insurance authorization preferred. - Strong knowledge of medical necessity criteria (e.g., ASAM, LOCUS, InterQual). - Excellent communication, organizational, and time management skills. - Proficiency in electronic health records and Microsoft Office Suite. Company Description

Role Description The Medical Records Clerk Appeals Specialist oversees the managing of patient health files in a facility. Their duties include: - Filing records - Assisting in audits - Collecting information - Supplying the nursing department with appropriate documents and forms This role serves as the primary point of contact for all record requests and ensures the accurate, timely, and confidential handling of clinical documentation for clients, families, referents, legal entities, payers, and regulatory agencies. Additionally, the position supports the Utilization Review team by preparing and tracking written insurance appeals. Qualifications - Strong knowledge of HIPAA and confidentiality regulations - Familiarity with AHCA, DCF, and CARF standards - Ability to manage high volumes of requests while maintaining accuracy and timeliness - Excellent attention to detail and organizational skills - Proficiency in EHR platforms (e.g., BestNotes) and Microsoft Office Suite - Strong written and verbal communication skills - Professional discretion and ability to maintain confidentiality in all matters - Understands and maintains professional boundaries - Demonstrates an understanding of rules/limits of patient confidentiality and maintains appropriate levels of client confidentiality/privacy - Demonstrates consideration of and respect for values and cultural beliefs Requirements - High School Diploma or GED required - Associate’s or bachelor’s degree in health information management, Healthcare Administration, or related field preferred - Minimum of 2 years in medical records, health information management within a behavioral health or healthcare setting - Experience with payer appeals and electronic health record systems preferred - Valid Florida Driver’s License - Current CPR and First Aid Certification, or willingness to complete within the first 30 days of employment - Clearance of TB test Benefits - Pay rate: $20.00 to $22.00 an hour based on experience - Remote work opportunity - Monday through Friday hours: 8:30 AM to 5:00 PM