Appeals Support Specialist

Summary

Join Discovery Behavioral Health as an Appeals Support Representative and contribute to the creation of life-changing programs and treatment centers nationwide. This full-time remote position supports the Clinical Appeals Specialist in the administrative functions of Denials and Appeals within the Utilization Review Team. You will be responsible for completing outbound calls to payers, interacting with insurance representatives, tracking appeal status, and organizing payer correspondence. This role requires strong communication, organizational, and analytical skills, as well as experience with insurance follow-up and appeals. Discovery Behavioral Health offers a competitive compensation package, including 401(k), healthcare benefits, vacation and sick days, employee referral program, employee discounts, continuing education programs, weekly training opportunities, and advancement opportunities.

Requirements

• Associate’s degree required or High School Diploma plus 5-7 years of appeals and grievance experience; Bachelor’s degree preferred
• Ability to work Monday through Friday, 8:00am-4:30pm or 8:30am-5:00pm EST
• Ability to utilize and navigate Zoom and Microsoft Teams for remote meetings and IM chat
• Strong Microsoft Office skills (Excel, Word, Outlook)
• Experience with insurance follow up and/or appeals and grievances required
• Familiarity with medical billing, provider relations, and/or healthcare office experience required
• Ideal candidate must be a self-starter with strong attention to detail, the ability to multi-task, a high level of organization, and excellent communication skills
• Ability to remain flexible and adapt to changing situations
• Excellent customer service skills and strong analytical skills

Responsibilities

• Complete outbound calls to payers for status updates on retro authorization requests and appeal submissions
• Interact with third party insurance representatives and utilize online sites to review retro authorization and appeal status
• Track and confirm weekly status updates on all outstanding appeal cases until final resolution
• Request, track, and receive payer correspondence regarding approvals and denials to include acknowledgment letters and determination letters
• Organize and scan all payer determination letters in KIPU charting system and update the Clinical Appeals Specialist within 24 hours of receipt
• Document final appeal outcomes as well as case details in KIPU chart system and appeal spreadsheet
• Responsible for obtaining patient and/or guardian signatures on required payer consent forms
• Submit retro authorization requests, provide support for retro SCA projects, and follow up on retro auth submissions until final resolution
• Identify problem cases and escalate issues to Clinical Appeals Specialist as appropriate
• Attend and participate in all monthly UR Team meetings and all quarterly Denials meetings
• Adhere to privacy and HIPAA guidelines
• Perform and/or assist with special projects as assigned

Benefits

• 401(k)
• Healthcare benefits
• Vacation and sick days
• Employee referral program
• Employee discounts to various stores, amusement parks, events, etc
• Continuing education (CE) programs and training
• Weekly training opportunities
• Advancement opportunities within the organization