Coordinator, Appeals

Lifepoint Health • Louisville, KY

1d

About The Position

The Appeals Coordinator gathers all information required for an appeal, writes and submits appeals to insurance companies, performs follow-up, and maintains detailed documentation. This role utilizes clinical criteria guidelines and documentation to develop well-supported appeal arguments that demonstrate medical necessity, working both independently and collaboratively to support positive clinical and financial outcomes.

Requirements

• Strong critical thinking skills and decisive judgment
• Ability to work independently with minimal supervision
• Ability to function effectively in a fast-paced, potentially stressful environment
• Strong attention to detail and accuracy in financial transactions
• Effective communication and problem-solving skills
• Ability to manage multiple tasks and meet deadlines
• Requires Bachelor’s Degree in social work, RN or degree in a related behavioral health field and minimum of 2 years of experience in a managed care/healthcare setting; or any combination of education and experience, which would provide an equivalent background
• Computer proficiency in Microsoft Office applications and other software programs essential to perform job functions

Nice To Haves

• Previous utilization review experience in a psychiatric healthcare facility preferred

Responsibilities

• Gather all necessary documentation required for insurance appeals
• Write, prepare, and submit appeals to insurance companies in accordance with payer requirements
• Perform follow-up phone calls and status checks on submitted appeals
• Maintain accurate and detailed documentation of all appeal activities
• Apply clinical criteria guidelines to support medical necessity for inpatient and outpatient services
• Verify payer-specific appeal requirements including submission methods and timelines
• Manage large volumes of documents including copying, faxing, and scanning incoming materials
• Document and track appeal activity within tracking systems and mainframe systems
• Ensure appeals are completed accurately and within required timeframes
• Interface with managed care organizations, external reviewers, and other payers
• Access and utilize provider portals for appeal submission and follow-up
• Collaborate with Utilization Review (UR) staff and other departments to complete the appeal process efficiently

What This Job Offers

• Job Type: Full-time