Appeals Coordinator

Lifepoint Health • Brentwood, TN

2d • Remote

About The Position

The Appeals Coordinator gathers all information required for an appeal, writes, and submits the appeal to the insurance company, makes follow-up phone calls, and maintains documentation of all steps taken. The Appeals Coordinator clinical criteria guidelines and clinical documentation to develop sound and well-supported appeal arguments to support medical necessity. The Appeals Coordinator works independently and collaboratively with other departments to positively affect clinical and financial outcomes.

Requirements

• Bachelor’s Degree in social work, RN or degree in a related behavioral health field.
• Minimum of 2 years of experience in a managed care/healthcare setting.
• Previous utilization review experience in a psychiatric healthcare facility preferred.
• Computer proficiency in Microsoft Office applications and other software programs essential to perform job functions.
• Must be authorized to work in the United States without employer sponsorship.

Nice To Haves

• Display knowledge of clinical pertinence and managed care requirements to support medical necessity criteria for inpatient and outpatient levels of care.
• Verify the information needed by the insurance plan for an appeal, where to submit the appeal, and method of submitting appeal.

Responsibilities

• Gathers all information required for an appeal.
• Writes and submits appeals to insurance companies.
• Makes follow-up phone calls.
• Maintains documentation of all steps taken.
• Develops sound and well-supported appeal arguments to support medical necessity using clinical criteria guidelines and clinical documentation.
• Works independently and collaboratively with other departments to positively affect clinical and financial outcomes.
• Manages large volumes of documents including copying, faxing and scanning incoming mail.
• Documents and logs information on tracking systems and mainframe systems.
• Ensures appeals are completed thoroughly and on a timely basis.
• Interfaces with managed care organizations, external reviews, and other payers.
• Obtains access to various provider portals and utilizes portals for submitting appeals and following up on status of appeals when applicable.
• Communicates with facility UR staff when needed to efficiently complete the appeal process.

Benefits

• Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Ongoing learning and career advancement opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level