Utilization Review Specialist

Job description

Utilization Review Specialist – Exact Billing Solutions (EBS) 
Lauderdale Lakes, FL 

About Exact Billing Solutions 

Exact Billing Solutions is a unique team of medical billing professionals specializing in the substance use disorder, mental health, and autism care fields of healthcare services.

We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation.

With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies. 

EBS, owned by ICBD, a single-family office, is poised for exponential growth, and we are building out our teams to support the expansion of global operations. 

 ABOUT ICBD 

Headquartered in Fort Lauderdale, Florida, ICBD is a robust single-family office focused on private investment and business development, supporting exceptional companies in healthcare, technology, and beyond.

The organization champions entrepreneurial ingenuity, service, and action at the forefront of healthcare innovation.

ICBD is tearing down barriers to care and opening doors to new possibilities.  

ICBD is self-funded, committed to sustainable growth, and committed to sustainable growth, and led by visionary thought leaders—including our CEO and Founder, the 2024 Ernst & Young U.S. Entrepreneur Of The Year® National Overall Award winner.  

ICBD’s most visible success (and EBS’s largest client) is ABA Centers, a revolutionary leader in autism care and diagnostics, ranked #5 on the 2024 Inc.

5000 list of fastest-growing private companies in the U.S.  

The ICBD portfolio includes these dynamic organizations united by strategic vision, operational expertise, and unwavering commitment to excellence: 
 

• ABA Centers – The leading provider of autism care in the U.S., with 13 regional brands and 70+ operating areas. 

• GateHouse Treatment – A comprehensive network of substance use disorder programs that address the full spectrum of recovery needs from medical treatment to supportive housing and respite services.   

• Marquis MD – A concierge medicine concept redefining healthcare by prioritizing convenience, connection, and care powered by advanced technology.  

• Exact Billing Solutions – Innovative revenue cycle management and advanced billing support systems for healthcare providers. 

• Curative AI – A next-generation platform using AI to disrupt and transform the healthcare system by providing new solutions for revenue cycle management, scheduling, medical documentation, clinical and diagnostic support, and more. 

 Recognition & Awards 

ICBD’s commitment to operational excellence, ethical leadership, and transformative care has earned national and international recognition across industries.

ICBD companies and leadership have been honored with multiple awards, including: 
 

•    Inc.
  
  5000 – 5th Fastest-Growing Private Company in America (2024). 

•    Financial Times – #1 on The Americas' Fastest Growing Companies.
  
   

•    EY Entrepreneur Of The Year® U.S. Overall. 

•    South Florida Business Journal’s Top 100 Companies. 

•    Florida Trend Magazine's 500 Most Influential Business Leaders. 

•    Inc.
  
  Best in Business, Health Services. 

Requirements

About the Role

As a Utilization Review Specialist, you will play a pivotal role in ensuring the efficient and effective utilization of healthcare resources.

You will be responsible for reviewing and evaluating clinical documentation, treatment plans, and medical records to optimize patient care and streamline healthcare delivery processes.

The principal functions of the position identified shall not be considered as a complete description of all the work requirements and expectations that may be inherent in the position.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.

Key Responsibilities

The following are duties and responsibilities that the Utilization Review Specialist shall provide:

Clinical Documentation Review:

• Evaluate and analyze medical records, treatment plans, and clinical documentation to ensure accuracy and compliance with established standards.
• Collaborate with healthcare providers to gather additional information or clarification on documentation when necessary.

Utilization Review:

• Assess the appropriateness and necessity of healthcare services, ensuring they align with established guidelines and policies.
• Identify and communicate potential issues related to overutilization or underutilization of services.

Collaboration and Communication:

• Work closely with interdisciplinary teams, Board Certified Behavior Analysts, Registered Behavior Technicians, and other healthcare professionals to gather insights and ensure comprehensive reviews.
• Communicate findings and recommendations clearly and effectively to internal teams and external stakeholders.

Quality Improvement:

• Participate in quality-improvement initiatives to enhance the overall efficiency and effectiveness of healthcare delivery.
• Provide feedback and suggestions for process improvements based on review findings.

Regulatory Compliance:

• Stay informed on relevant healthcare regulations, guidelines, and accreditation standards.
• Ensure compliance with all applicable laws and regulations in the utilization review process.

Qualifications

The Utilization Review Specialist requires a minimum of a(n):

• Bachelor's degree in a healthcare-related field (Social Work, Mental Health Counseling, Physical Therapy, Occupational Therapy, Speech-Language Pathology, Nursing); Master's degree preferred.
• Relevant clinical licensure or certification (e.g., BCBA, LSW, LMHC, PT, OT, SLP, RN).
• Proven experience in utilization review or a related field with a strong understanding of healthcare service delivery and documentation processes is highly desirable.
• Up-to-date knowledge of relevant healthcare regulations, guidelines, and accreditation standards.
• Understanding of compliance requirements and the ability to ensure adherence during the utilization review process.
• Must maintain clean background/drug screenings and driving record

Expertise Needed

• Familiarity with industry standards, guidelines, and best practices related to utilization review.
• Ability to analyze complex clinical documentation, treatment plans, and medical records.
• Strong critical thinking skills to assess the appropriateness and necessity of healthcare services.
• Strong analytical and critical thinking skills.
• Excellent communication and interpersonal skills.
• Ability to work collaboratively in a team-oriented environment.

Benefits

• 21 paid days off (15 days of PTO, which increases with tenure, plus 6 holidays).
  
   

• Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
  
   

• Medical, dental, vision, long-term disability, and life insurance.
  
   

• Generous 401(k) with up to 6% employer match.
  
   

Exact Billing Solutions (EBS) Culture 

Integrity.

Dependability.

Attention to detail.

All our team members exhibit these qualities when it comes to doing business.

And when it comes to the business of supporting a team, as a company, we offer no less to our team members.

We’re a fast-paced, growing company delivering services that allow our clients to spend more time helping people.

At the end of the day, it’s people, not numbers, that drive our success. 

Exact Billing Solutions participates in the U.S. Department of Homeland Security E-Verify program. 

Required Skill Profession

Other Healthcare Practitioners And Technical Occupations