Behavioral Health Utilization / Authorization Specialist

Threshold Billing SolutionsSandy, UT, US

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Job Description

Behavioral Health Utilization / Authorization Specialist

Location : Sandy, Utah

Schedule : Full-time (40 hours / week, on-site)

Salary : $40,000 – $52,000 (based on experience)

About Us

Threshold Billing Solutions provides specialized claims processing and utilization management services for behavioral health treatment facilities. We work closely with providers, insurers, and managed care organizations to ensure clients receive the highest level of care supported by clinical necessity and payer requirements.

Position Summary

The Utilization / Authorization Specialist plays a key role in advocating for clients by obtaining treatment authorizations and facilitating communication between providers and insurance payers. This position is responsible for reviewing clinical documentation, submitting authorization requests, and ensuring accurate, timely tracking of coverage. The ideal candidate will be detail-oriented, organized, and capable of communicating clearly with both internal teams and external insurance representatives.

Key Responsibilities

Maintain proactive and effective communication with insurance payers and managed care organizations.
Review and interpret clinical documentation, case notes, and assessments to determine and advocate for the appropriate level of care.
Prepare and submit initial and concurrent authorization requests, as well as appeals when necessary.
Enter and update authorization details in internal data systems accurately and promptly.
Track ongoing authorization needs across all levels of care (RTC, PHP, IOP, OP).
Communicate with facility staff and internal departments regarding client coverage and clinical needs.
Serve as a client advocate, ensuring access to appropriate care through effective payer communication.
Ensure timely documentation of all authorizations, decisions, and payer communications.
Perform other related duties as assigned.

Qualifications

Experience in behavioral health or utilization review preferred (but not required).

Knowledge of CPT / ICD-10 coding, ASAM / LOCUS criteria, and EMR systems is a plus.

Strong verbal and written communication skills.

Excellent organization and attention to detail; able to manage multiple tasks and priorities.

Critical thinking and analytical skills with the ability to interpret and present clinical information.

Ability to work independently and as part of a collaborative team.

Proficiency in Microsoft Office and Google Workspace.

Comfortable working in a fast-paced environment with deadlines and competing priorities.

Education & Experience

High school diploma or equivalent required. Associate’s degree or higher preferred.

At least 1 year of experience in behavioral health or utilization review preferred (not required).

Prior experience in the substance use and / or mental health treatment field is highly valued.

Benefits

Health, dental, and vision insurance

Paid time off (PTO)

Life insurance

Short- and long-term disability coverage

Supportive, team-oriented work environment

Work Environment

This is a full-time, on-site position located at our Sandy, Utah office.

To Apply : Please submit your resume and a brief cover letter detailing your interest in the role and relevant experience.

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Behavioral Health Specialist • Sandy, UT, US