APPEALS SPECIALIST
About The Position
This position is responsible for monitoring insurance denials by running relevant reports and documenting appeal results in MS4 and MIDAS, ensuring proper notification to providers and members. The individual oversees staff handling post-discharge provider authorization disputes and "take-backs" related to clinical authorization and closed chart denials. The role requires close coordination with HIM to retrieve charts and collaboration with facility clinicians to obtain missing information, ensuring a strong appeal case. Additionally, they manage the denials and appeals process for designated facilities within FRN, coordinating with facility and CBO personnel while maintaining accurate reporting documentation for staff and supervisors.
Requirements
- High School Graduate/GED Required.
- 1-3 Years Related work experience required
- Excellent verbal and written communication skills required.
- Solid clinical background in providing substance abuse and or mental health treatment.
- Familiarity with the utilization process involved in working with health plans.
- Proficient in Microsoft Suite for word processing, spreadsheets, and presentations.
- Good understanding of dual diagnosis treatment.
Nice To Haves
- Associate's Degree preferred
Responsibilities
- Monitors insurance denials by running appropriate reports.
- Continuously and thoroughly documents in both MS4 and MIDAS the results of the appeals and dispositions at all levels including notification to providers and members.
- Manages the staff responsible for all post-discharge provider authorization disputes, and provider “take-backs” due to clinical authorization and closed chart denial appeals.
- Works with HIM to retrieve charts and facility clinicians to obtain any missing information in a timely manner to ensure the best possible case for appeal is submitted.
- Resolves issues associated with the appeals between other internal departments of the BO or external departments of the facilities served.
- Manages caseload and is responsible for all post-discharge provider authorization disputes and provider “take-backs” due to clinical authorization and closed chart denial appeals on their caseload.
Benefits
- Excellent Medical, Dental, Vision and Prescription Drug Plan.
- 401k plan with company match
- Generous Paid Time Off
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
