Utilization Review Manager

FIGUR8 is seeking an Operations Utilization Review Manager to join our Payer Success Team. Our ideal candidate is a proactive and motivated individual with a strong background in coordinating and managing utilization review and billing processes. This role demands exceptional attention to detail and outstanding organizational skills, as the successful candidate will play a vital role in ensuring the efficiency and accuracy of our operational procedures. If you thrive in a fast-paced environment and are passionate about enhancing customer success, we encourage you to apply.

About Us

FIGUR8 is the market leader for standardizing musculoskeletal (MSK) health and injury recovery data. Through our innovative bioMotion Assessment Platform (bMAP), FIGUR8 empowers individuals to monitor and optimize their injury recovery, physical performance and overall health, while enabling providers, patients, and payers to access valuable data for advanced insights, better recovery, and more personalized care. Responsibilities: • Oversee and coordinate the utilization review process, ensuring compliance with internal policies and external regulations. • Collaborate with case managers and insurance companies to evaluate the appropriateness of medical services. • Prepare and present comprehensive reports on utilization review findings to management and relevant stakeholders. • Maintain accurate documentation of all review processes and decisions in accordance with regulatory requirements. • Manage the entire billing process, ensuring timely and accurate invoicing for provider payments. • Work with client success teams to resolve billing inquiries and discrepancies. • Perform data entry and maintain accurate billing records in the billing system. • Identify and implement process improvements to enhance billing efficiency and accuracy. Qualifications: • Bachelor's degree in healthcare administration or a related field preferred • Minimum of 3 years of experience in healthcare operations, utilization review management, or a related role. • Strong knowledge of medical terminology, coding, and insurance reimbursement processes. Experience with Worker's Compensation is a plus. • Excellent analytical skills with the ability to interpret complex data and prepare reports. • Proficient in Google Suite and MS Office and familiarity with healthcare management software • Proficient in billing software and Microsoft Excel • Outstanding verbal and written communication skills, with the ability to collaborate effectively across various departments. • Strong organizational skills and the ability to manage multiple priorities and projects in a fast-paced environment. • Demonstrated ability to work collaboratively within a team and independently. Benefits: • 401(k) • Medical, Dental, Vision Apply Job!