Appeals Coordinator

Springstone

What we Treat a full range of mental health and addiction care including: Depression Anxiety PTSD Borderline Personality Disorder Bipolar Disorder Psychosis Suicidal and Homicidal Ideations Drug and Alcohol Addiction.

Our Programs Full continuum of care; 24/7 crisis care and assessment; inpatient mental health treatment inpatient drug and alcohol detox and rehab partial hospitalization programs (PHP); intensive outpatient programs (IOP); virtual assessments virtual outpatient care.

Populations Served Adult child and adolescent military veterans first responders and other high-risk frontline professionals (Help for Heroes program)

Summary:

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 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.

Qualifications:

Education:

• Requires Bachelors Degree in social work RN or degree in a related behavioral health field

Experience:

• 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

• Previous utilization review experience in a psychiatric healthcare facility preferred

Additional Requirements:

• Computer proficiency in Microsoft Office applications and other software programs essential to perform job functions

Job Responsibilities:

• 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 logs 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.

PHYSICAL MENTAL AND SPECIAL DEMANDS
1. Ability to sit and stand (at least two-thirds of the shift) and walk (possibly one-third of the shift).
2. Ability to reach above or below waist height kneel bend stoop turn and twist (occasionally to frequently).
3. Visual ability to read charts treatment plans financial documents computer screen and typewritten materials.
4. Ability to frequently push/pull wheeled carts to 100 pounds.
5. Ability to frequently lift and carry 10 lbs.; occasionally 20 to 50 lbs.
6. Ability to work in an environment where chemicals are frequently used for cleaning where medical and electrical hazards may be present and where dust mist and steam are frequently generated in housekeeping tasks.
Ability to work at a rapid pace and perform a variety of repetitive duties.

EEOC Statement:

Springstone is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color race sex age religion national origin disability genetic information gender identity sexual orientation veterans status or any other basis protected by applicable federal state or local law.