Behavioral Health Clinical Appeals Reviewer

Key Responsibilities

• Coordinate clinical appeals/grievances and complaints for Behavioral Health
• Report and monitor appeals
• Schedule and facilitate appeals according to regulatory requirements
• Analyze appeals data
• Determine appeals decisions
• Prepare cases for Medical Director review

Requirements

Education

Master's degree or RN license

Experience

4 years clinical experience post licensure at independent practice level

Required Skills

• Knowledge of state and federal guidelines
• Written and verbal communication
• Interpersonal skills
• Organizational skills
• Detail oriented
• Microsoft Excel proficiency
• Claims experience
• Data Analytics
• Electronic Records management
• Utilization Review (UR)

Required Certifications

• Current RN license or Masters-level Behavioral Health Professional license (LPC, LMFT, LCSW, LCPC)

Benefits

• Annual Performance Incentive (Bonus)
• Total Rewards Package