Behavioral Health Appeals Coordinator Senior (BCBA)
About The Position
The Behavioral Health Appeals Coordinator Senior investigates and processes complex grievances and appeals from members and providers related to behavioral health services. The role serves as a technical resource for the team and may support projects involving medical policy and managed care initiatives. The position is hybrid, requiring associates to work in an office 1–2 days per week. Candidates must live within a reasonable commuting distance of an Elevance Health office, unless an accommodation is granted as required by law. Alternate locations may be considered for candidates within commuting distance. The position is classified as non-management exempt. The salary range for candidates working in person or virtually in the listed locations is $73,280 to $109,920. Actual compensation depends on factors including location, experience, education, and skills. Elevance Health offers a comprehensive benefits package, subject to eligibility requirements.
Requirements
- Master’s degree in social work, an RN qualification, or a degree in a related behavioral health field, and at least 4 years of experience in a managed care or healthcare setting; alternatively, an equivalent combination of education and experience.
- Current, active, unrestricted license as a Licensed Clinical Social Worker, Marriage and Family Therapist, Clinical Psychologist, Licensed Professional Counselor, or RN license to practice within the scope of licensure in applicable U.S. state(s) or territory.
Nice To Haves
- Board Certified Behavior Analyst (BCBA) certification is strongly preferred.
- Experience as an Appeals Reviewer is highly preferred.
- Specialized background working with individuals diagnosed with autism spectrum disorder (ASD) is preferred.
Responsibilities
- Investigate and review member and provider grievances and appeals, including complex issues.
- Serve as an internal resource for lower-level behavioral health appeal coordinators and staff.
- Review prospective, inpatient, and retrospective medical records related to denied services for medical necessity.
- Extract and summarize medical information for medical directors, consultants, and external reviewers.
- Prepare recommendations to uphold or deny appeals and forward them to a medical director for approval.
- Ensure appeals and grievances are resolved within regulatory timeframes.
- Document and log information in tracking and mainframe systems.
- Prepare written correspondence for providers, members, and regulatory entities.
- Participate in projects affecting the development, interpretation, and implementation of medical policy or other managed care initiatives.
Benefits
- Comprehensive benefits package, subject to eligibility requirements
- Incentive and recognition programs
- Equity stock purchase
- 401(k) contribution
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs, unless covered by a collective bargaining agreement
- Medical benefits
- Dental benefits
- Vision benefits
- Short- and long-term disability benefits
- 401(k) with match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Senior
