Coordinator, Appeals

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 including:

• 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 and outpatient care

Populations Served

• Adults
• Children and adolescents
• Military and veterans
• First responders and frontline professionals (Help for Heroes program)

Summary:

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.

Essential Functions:

• 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

Knowledge Skills and Abilities:

• 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

Education & Experience:

Education:Requires Bachelors 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

Experience:

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

• May be required to work flexible hours and overtime

Reports to:Business office Supervisor

FLSA Status:

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.

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