Appeals Support Representative

Discovery Behavioral Health

3d•$24 - $26•Remote

About The Position

Discovery Behavioral Health (DBH) is a national leader in behavioral healthcare and one of the fastest growing companies in the field. DBH offers world-class treatment for those struggling with eating disorders, mental health, and substance use and places a high priority on seeking employees who share our passion for improving the lives we serve. Since 1997, Discovery Behavioral Health has helped thousands of patients discover their path to the full and rewarding lives they deserve with evidence-based and inclusive treatment options. Position Summary: The Appeals Support Representative role directly supports the Clinical Appeals Specialist in the administrative functions of Denials and Appeals within the Utilization Review Team.

Requirements

Associates Degree required or High School Diploma plus 5-7 years of appeals and grievance experience; Bachelor’s degree preferred.
Ability to work Monday through Friday, 8:00am-4:30pm or 8:30am-5:00pm EST.
Ability to utilize and navigate Zoom and Microsoft Teams for remote meetings and IM chat.
Strong Microsoft Office skills (Excel, Word, Outlook)
Experience with insurance follow up and/or appeals and grievances required.
Familiarity with medical billing, provider relations, and/or healthcare office experience required.

Responsibilities

Complete outbound calls to payers for status updates on retro authorization requests and appeal submissions.
Interact with third party insurance representatives and utilize online sites to review retro authorization and appeal status.
Track and confirm weekly status updates on all outstanding appeal cases until final resolution.
Request, track, and receive payer correspondence regarding approvals and denials to include acknowledgment letters and determination letters.
Organize and scan all payer determination letters in KIPU charting system and update the Clinical Appeals Specialist within 24 hours of receipt.
Document final appeal outcomes as well as case details in KIPU chart system and appeal spreadsheet.
Responsible for obtaining patient and/or guardian signatures on required payer consent forms.
Submit retro authorization requests, provide support for retro SCA projects, and follow up on retro auth submissions until final resolution.
Identify problem cases and escalate issues to Clinical Appeals Specialist as appropriate.
Attend and participate in all monthly UR Team meetings and all quarterly Denials meetings.
Adhere to privacy and HIPAA guidelines.
Perform and/or assist with special projects as assigned.