Appeals Coordinator- Remote

Lifepoint Health • Louisville, KY

5d • Remote

About The Position

At Lifepoint Health, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. As a member of the Health Support Center (HSC) team, you’ll support those that are in our facilities who are interfacing and providing care to our patients and community members to positively impact our mission of making communities healthier ®.

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
• 3-5 years of experience in a managed care/healthcare setting
• 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

• Previous utilization review experience in a psychiatric healthcare facility preferred
• May be required to work flexible hours and overtime

Responsibilities

• 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.
• Utilizes clinical criteria guidelines and clinical documentation to develop sound and well-supported appeal arguments to support medical necessity.
• Works independently and collaboratively with other departments to positively affect clinical and financial outcomes.
• Displays knowledge of clinical pertinence and managed care requirements to support medical necessity criteria for inpatient and outpatient levels of care.
• Verifies the information needed by the insurance plan for an appeal, where to submit the appeal, and method of submitting appeal.
• 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