Senior Behavioral Health Appeals Coordinator, BCBA, Ohio BH Licensed

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Conduct investigations and evaluations of member and provider grievances and appeals.

• Address complex issues related to behavioral health.

• Act as an internal resource for junior behavioral health appeal coordinators and support staff.

• Review medical records of denied services, whether prospective, inpatient, or retrospective, for medical necessity.

• Extract and summarize medical information for medical directors, consultants, and other external reviewers.

• Prepare recommendations to either uphold or deny appeals and submit them to the medical director for approval.

• Ensure timely resolution of appeals and grievances to comply with regulatory timelines.

• Record and log information on tracking systems and mainframe systems.

• Create written communications for providers, members, and regulatory bodies.

• Engage in projects that support the development, interpretation, and implementation of medical policies and managed care initiatives.

⛳️ Requirements

• A Master's degree in social work, nursing, or a related behavioral health field, with a minimum of 4 years of experience in a managed care or healthcare setting; or any combination of education and experience that provides an equivalent background.

• A current active unrestricted license as a Licensed Clinical Social Worker, Marriage and Family Therapist, Clinical Psychologist, Licensed Professional Counselor, or RN license to practice as a healthcare professional within the scope of licensure in the applicable state(s) or territory of the United States.

• Eligibility to reside in Ohio.

• Must live within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law.

• Board Certified Behavior Analyst (BCBA) is highly preferred.

• Experience as an Appeals Reviewer is strongly preferred.

• Specialized experience working with individuals diagnosed with autism spectrum disorder (ASD) is preferred.

🏝️ Benefits

• Comprehensive benefits package.

• Incentive and recognition programs.

• Equity stock purchase options.

• 401k contributions.

• Merit-based salary increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short and long-term disability benefits.

• 401(k) plan with matching contributions.

• Stock purchase plan.

• Life insurance.

• Wellness programs.

• Financial education resources.

• Virtual full-time work arrangement, except for mandatory in-person training sessions.

• Support and requirement for COVID-19 and Influenza vaccinations for certain patient/member-facing roles.