[Hiring] Appeals Coordinator @Lifepoint Health

Role Description

The Appeals Coordinator gathers all information required for an appeal, writes, and submits the appeal to the insurance company, makes follow-up phone calls, and maintains documentation of all steps taken. The Appeals Coordinator uses clinical criteria guidelines and clinical documentation to develop sound and well-supported appeal arguments to support medical necessity. The Appeals Coordinator works independently and collaboratively with other departments to positively affect clinical and financial outcomes.

How you’ll contribute:

• Display knowledge of clinical pertinence and managed care requirements to support medical necessity criteria for inpatient and outpatient levels of care.
• Verify the information needed by the insurance plan for an appeal, where to submit the appeal, and method of submitting appeal.
• Manage large volumes of documents including copying, faxing and scanning incoming mail.
• Document and log information on tracking systems and mainframe systems.
• Ensure appeals are completed thoroughly and on a timely basis.
• Interface with managed care organizations, external reviews, and other payers.
• Obtain access to various provider portals and utilize portals for submitting appeals and following up on status of appeals when applicable.
• Communicate with facility UR staff when needed to efficiently complete the appeal process.

Qualifications

• Bachelor’s Degree in social work, RN or degree in a related behavioral health field.
• 3-5 years of experience in a managed care/healthcare setting.

Requirements

• Previous utilization review experience in a psychiatric healthcare facility preferred.
• Computer proficiency in Microsoft Office applications and other software programs essential to perform job functions.
• May be required to work flexible hours and overtime.

Benefits

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development: Ongoing learning and career advancement opportunities.