BH Shared Services (a UHS company) is currently seeking an experienced Market Appeals Specialist to join our established team in the Central Appeals Office.
POSITION SUMMARY: This position supports utilization management and shared services within the behavioral health division. This role oversees and completes all standard appeals within a designated market, including both Cerner and non-Cerner facilities.
A successful candidate must have knowledge of utilization management operations, including experience with appeal letters and payer engagement. The ability to apply clinical acumen in a behavioral health setting both verbally and in writing is essential to this role. *This is a fully remote position.
RESPONSIBILITIES:
- Complete all standard appeals timely and manage appeal inventory through ongoing tracking and monitoring.
- Act as a liaison with local facilities and payers to ensure timely appeal processing including appropriate follow-up with payers for facility reimbursement.
- Participate in local facility UM team meetings to support the standard appeal process.
- Provide feedback to providers and UM team on opportunities impacting facility recoveries (e.g., documentation)
- Performs other duties as assigned/required by this position
This opportunity provides the following:
- UHS offers a challenging and rewarding work environment
- Growth and development opportunities within UHS and its subsidiaries
- Competitive Compensation
- Excellent Medical, Dental, Vision and Prescription Drug Plan.
- 401k plan with company match
- Generous Paid Time Off
REQUIREMENTS:
- Bachelor's degree required, Master's preferred
- RN License or Master's level clinician required,Licenusre preferred
- 3-5 years related experience required, 5-8 preferred
- Knowledge of utilization management operations, including experience with appeal letters and payer engagement.
- Proficient in Excel, Microsoft Office/Teams, Word, and database inventory management.
- Knowledge of payer requirements for reimbursement across all levels of care and behavioral health business office operations.
- Strong oral communication skills to represent patient progress and treatment in behavioral health.
- Understanding of medical necessity criteria application for all levels of care.
- Ability to apply clinical acumen in behavioral health to written correspondence.
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
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Pay: $69,000.00 - $99,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Education:
License/Certification:
- LCSW-C (Preferred)
- LPC (Preferred)
Work Location: Remote
