Utilization Review Coordinator | Remote
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Job Summary
About the Organization
Lotus Healthcare Billing is a behavioral health billing operation based in Boca Raton Florida supporting treatment programs through insurance authorization utilization review and payer communication. The team works closely with clinical staff to ensure that patients can access the levels of care they need from detox through outpatient services.
The Opportunity
We are seeking a detail-oriented Utilization Review Coordinator to join the Lotus Healthcare Billing team. This full-time remote role is well suited to someone who is organized communicates clearly and is comfortable managing a caseload where timelines directly affect patient care. A hybrid schedule with time in the Boca Raton office may be available for the right candidate. No prior utilization review experience is required. Training will be provided for the right candidate.
What Youll Do
- Conduct daily phone contact with insurance companies to secure authorizations for behavioral health and substance use disorder treatment.
- Manage a caseload of active authorizations tracking timelines closely since they directly affect patient care.
- Apply knowledge of SUD and behavioral health levels of care including detox residential PHP IOP and outpatient when communicating with payers.
- Reference ASAM criteria and medical necessity standards to support authorization requests.
- Use systems such as KIPU Availity or other payer portals to document and track review activity.
- Communicate professionally and consistently with insurance representatives and internal clinical teams.
- Work independently while staying aligned with program and compliance expectations.
Requirements
- High school diploma or equivalent required; associates or bachelors degree a plus.
- Less than one year of relevant experience required; training provided for the right candidate.
- Experience in utilization review insurance authorization or behavioral health billing preferred.
- 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.
- Clear professional communication skills.
- Comfortable working independently and managing a caseload.
- Reliable home internet and a private HIPAA-compliant workspace for remote work.
Compensation and Schedule
- Salary: $50000 to $80000 annually commensurate with experience.
- Schedule: Days full-time remote (hybrid option available for the right candidate).
This opportunity is posted by Atlantic Health Strategies on behalf of Lotus Healthcare Billing in Boca Raton Florida.
Required Skills:
Insurance authorization utilization review ASAM criteria medical necessity review KIPU Availity payer portal documentation caseload management
Required Education:
High school diploma or equivalent required; associates or bachelors degree a plus
