> Markdown version of [/jobs/ext/1408205-um-specialist](https://www.wearedevelopers.com/jobs/ext/1408205-um-specialist). Every page supports `.md` or `Accept: text/markdown`. Links point to the HTML versions so they work for humans too. Agent guide: [/agents.md](https://www.wearedevelopers.com/agents.md). --- # UM SPECIALIST - **Company:** PIKE COUNTY RECOVERY COUNCIL - **Location:** Waverly, OH, United States - **Experience:** Starter - **Contract:** Permanent contract - **Skills:** PHP (Programming Language), Microsoft Excel, Clinical Terminology Servers, Web Portals, Peer-To-Peer (P2P), Software Tools, Electronic Medical Records, Navinet, Data Management - **Published:** July 23, 2026 - **Apply:** https://www.indeed.com/viewjob?jk=0ebd158570266a62 ## About the Role * Education: High school diploma or GED required. An Associate's or Bachelor's is strongly preferred. * Experience: 1-3 years of experience in prior authorization, medical billing, utilization review (UR), or patient access within a behavioral health or addiction treatment setting., Behavioral health payers rely on precise criteria to approve levels of care. Candidates generally must demonstrate: * ASAM Criteria Knowledge: Understanding of the American Society of Addiction Medicine (ASAM) criteria across dimensions (e.g., Level 3.5 Residential vs. Level 2.1 IOP) to support medical necessity for SUD treatment. * Diagnostic & Clinical Terminology: Familiarity with DSM-5 / ICD-10 coding, medical terminology, and psychiatric terminology (e.g., detox protocols, dual diagnosis, PHP, IOP, outpatient). * Parity & Regulatory Awareness: Basic understanding of the Mental Health Parity and Addiction Equity Act (MHPAEA), HIPAA compliance, and state-specific behavioral health regulations. * Payer-Specific Guidelines: Familiarity with commercial insurance (e.g., Optum, Beacon/Carelon, BCBS) and Medicaid/Medicare utilization guidelines for mental health and addiction services. Technical & Software Skills * EHR/EMR Systems: Hands-on experience with Carelogic. * Payer Portals: Proficiency navigating web portals (e.g., Availity, NaviNet, Provider Express) to submit authorizations, check concurrent review statuses, and track approvals. * Data Management: Proficiency with Microsoft Excel/Google Sheets for tracking authorization lifecycles, expiration dates, and authorized unit counts. Core Core Competencies * Clinical Translation: Ability to read therapist notes, biopsychosocial assessments, and nursing documentation, extracting key risk factors (e.g., SI/HI, withdrawal symptoms, relapse risk) to present to insurance medical directors. * Urgency & Time Management: Ability to manage tight turnaround windows for emergency or acute admissions (e.g., detox or inpatient stabilization requests often require submission within 24 hours of admission). * Appeal & Peer-to-Peer Coordination: Experience handling initial denial appeals, gathering peer-to-peer review documentation, and coordinating physician-to-doctor discussions. * Attention to Detail: Precision in matching authorized billing codes (CPT/HCPCS) with authorized dates of service to prevent revenue cycle rejections. ## Related Videos - [From Bedside Beeps to Interoperable Bytes – Getting your medical devices ready to talk the IEEE 11073 language](https://www.wearedevelopers.com/videos/771-from-bedside-beeps-to-interoperable-bytes-getting-your-medical-devices-ready-to-talk-the-ieee-11073-language) - [From clicks to cribs - How to find your dream home with web scraping](https://www.wearedevelopers.com/videos/767-from-clicks-to-cribs-how-to-find-your-dream-home-with-web-scraping) - [ Secure Code Superstars: Empowering Developers and Surpassing Security Challenges Together](https://www.wearedevelopers.com/videos/422-secure-code-superstars-empowering-developers-and-surpassing-security-challenges-together) - [Migrating half a million users to a new payment service provider](https://www.wearedevelopers.com/videos/730-migrating-half-a-million-users-to-a-new-payment-service-provider) - [Transforming Task Management: Integrating Camunda with Scalable Frontend Solutions](https://www.wearedevelopers.com/videos/1433-transforming-task-management-integrating-camunda-with-scalable-frontend-solutions) - [Old tools, new tricks](https://www.wearedevelopers.com/videos/1916-old-tools-new-tricks) ## Related Articles - [Coding and Mental Illness. 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