MARKET APPEALS SPECIALIST

UHS•Scottsdale, AZ

9d•Remote

About The Position

BH Shared Services (a UHS company) located in Brentwood, TN is currently seeking an experienced Market Appeals Specialist to join our established team. POSITION SUMMARY: Market Appeals Specialist This position supports utilization management and shared services within the behavioral health division. This role oversees and completes all standard appeals within a designated market, including both Cerner and non-Cerner facilities. A successful candidate must have knowledge of utilization management operations, including experience with appeal letters and payer engagement. The ability to apply clinical acumen in a behavioral health setting both verbally and in writing is essential to this role. This is a fully remote position.

Requirements

Bachelor's degree required, Master's preferred
RN License or Master's level clinician required,Licenusre preferred
3-5 years related experience required, 5-8 preferred
Knowledge of utilization management operations, including experience with appeal letters and payer engagement.
Proficient in Excel, Microsoft Office/Teams, Word, and database inventory management.
Knowledge of payer requirements for reimbursement across all levels of care and behavioral health business office operations.
Strong oral communication skills to represent patient progress and treatment in behavioral health.
Understanding of medical necessity criteria application for all levels of care.
Ability to apply clinical acumen in behavioral health to written correspondence.

Nice To Haves

Master's preferred
Licenusre preferred
5-8 preferred

Responsibilities

Complete all standard appeals timely and manage appeal inventory through ongoing tracking and monitoring.
Act as a liaison with local facilities and payers to ensure timely appeal processing including appropriate follow-up with payers for facility reimbursement.
Participate in local facility UM team meetings to support the standard appeal process.
Provide feedback to providers and UM team on opportunities impacting facility recoveries (e.g., documentation)
Performs other duties as assigned/required by this position