[Hiring] Appeals Support Representative @Discovery Behavioral Health

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Role Description

The Appeals Support Representative role directly supports the Clinical Appeals Specialist in the administrative functions of Denials and Appeals within the Utilization Review Team.
• 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.

Qualifications
• Associates 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.

Requirements
• Employment Status: Full-Time
• Schedule: Monday - Friday between 6am - 2pm or 6:30am - 2:30pm
• Work Location: Remote
• Compensation: Pay Range: $24-26/per hour

Benefits
• Discovery Behavioral Health seeks to build a diverse staff that is reflective of the patients we serve and the communities where we work.
• DBH encourages multiple perspectives, experiences, and strives to hire and retain a diverse workforce.
• We are proud to be an EEO employer M/F/D/V.
• We maintain a drug-free workplace and perform pre-employment substance abuse testing.
• All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, or national origin.

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