Appeals Support Representative

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Discovery Behavioral Health DBH

Appeals Support Representative

Irvine, CA
Full Time
Paid
  • Responsibilities

    Job 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.

    _ This is a full-time remote position that will work Monday through Friday, 8:00am-4:30pm EST or 8:30-5:00pm EST._

    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.

  • Qualifications

    Qualifications

    • 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.

    Not sure if you meet all the qualifications? Apply anyway! To provide truly innovative care, we need to have a diverse team around us. That’s why Discovery Behavioral Health is committed to creating an inclusive environment. If you find yourself meeting some but not all the above, we’d be happy to consider your application.

    Additional Information

    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.

    For more information about our company benefits, please visit us at discoverybehavioralhealth.com/careers/

    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.