BH Clinical Appeals Reviewer

BASIC FUNCTION:
This position is responsible for coordinating clinical appeals/grievances and complaints for Behavioral Health; reporting, monitoring, scheduling and facilitating appeals according to various regulatory requirements; analyzes appeals data, determine appeals decisions or prepare cases for Medical Director review.

JOB REQUIREMENTS:
• Masters- level Behavioral Health Professional ( LPC or LCSW ) to practice at the independent practice level with current license in good standing in state of operations.
•4 years clinical experience to include implementing or administering managed care or quality assurance activities.
•Knowledge and understanding of state and federal guidelines and regulations.
•Written and verbal communication skills and facilitating skills.
•Interpersonal skills to interface with internal and external customers, including representative of Department of Insurance and government agencies in a rapport-developing manner.
•Organizational skills.
•Detail oriented.

PREFERRED JOB REQUIREMENTS:
•Bilingual in English and Spanish.
•Experience in processing appeals, denials or grievances in accordance with regulatory or accreditation requirements.
•Experience in Utilization Management or audit.

•CA

•CB

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Requirements: Expertise Behavioral Health Job Type Full-Time Regular Location TX - Richardson


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