Utilization Review Coordinator - Full-time / Part-time

Founded in 1980, The MENTOR Network is a national network of local human services providers offering an array of quality, community-based services in more than 30 states to adults and children with intellectual and developmental disabilities, brain and spinal cord injuries and other catastrophic injuries and illnesses, and to youth with emotional, behavioral and medically complex challenges as well as their families.

For Pennsylvania Mentor and The MENTOR Network, a Utilization Review Coordinator is critical to our success and exemplifies the wonderful mission driven work we do here every day. As a Utilization Review Coordinator with Pennsylvania Mentor you’ll be one of those special people.

To that end, the Utilization Review Coordinator role is a fantastic role to continue your career path in Social and Human Services with a myriad of career options to move up and across the organization.

This individual will also assist in enhancing quality assurance measures as evidenced by increased compliance with applicable regulations. The Utilization Review Coordinator may also coordinate and distribute workflow for assigned staff.

UR Coordinator/BHRS Specialist primary duties;

• Record revenue for weekly services provided
• Complete various weekly and monthly reports related to service delivery, revenue and authorizations within required time frames
• Conduct QA reviews on weekly revenue reports
• Reconcile claim denials as assigned
• Track and reconcile any services categorized as unable to bill, work with Program Operations for resolution
• Operate Excel documents and ACCESS database for reporting
• Communicate with other department staff with issues related to authorizations and eligibility
• Review Promise eligibility of assigned BHRS consumers weekly
• Assist Program Operations in calculating service hours provided vs. service hours authorized
  

Requirements:

• High School Diploma or equivalent

• Knowledge with authorization process and revenue reporting preferred

Founded in 1980, The MENTOR Network is a national network of local human services providers offering an array of quality, community-based services in more than 30 states to adults and children with intellectual and developmental disabilities, brain and spinal cord injuries and other catastrophic injuries and illnesses, and to youth with emotional, behavioral and medically complex challenges as well as their families.


EOE/AAE