Utilization Review Coordinator | Remote
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 You'll 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
Requirements High school diploma or equivalent required; associate's or bachelor's 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.
Benefits
Compensation and Schedule Salary: $50,000 to $80,000 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.