Appeals Support Representative

Discovery Behavioral Health; Irvine (CA); Remote; USD 10,000 - 60,000; Full time

Job summary

An established industry player is seeking a dedicated Appeals Support Representative to join their innovative team. In this full-time remote role, you will play a critical part in the administrative functions of denials and appeals within the Utilization Review Team. Your responsibilities will include making outbound calls to payers, tracking appeal statuses, and ensuring compliance with privacy regulations. This is a fantastic opportunity to contribute to life-changing programs while enjoying a supportive work environment that values diversity and growth. If you're passionate about making a difference in healthcare, this role is for you.

Benefits

401(k)

Healthcare benefits

Vacation and sick days

Employee referral program

Employee discounts

Continuing education programs

Weekly training opportunities

Advancement opportunities

Qualifications

• Associate's degree or High School Diploma with 5-7 years of experience required.
• Proficiency with Microsoft Office and remote meeting tools.
• Experience with insurance follow-up and appeals is essential.

Responsibilities

• Make outbound calls for status updates on authorization requests.
• Document appeal outcomes and maintain accurate records.
• Adhere to HIPAA guidelines and participate in team meetings.

Skills

Microsoft Office (Excel, Word, Outlook)

Customer Service

Analytical Skills

Insurance Follow-up

Attention to Detail

Education

Associate's Degree

High School Diploma with 5-7 years experience

Bachelor's Degree

Tools

Zoom

Microsoft Teams

KIPU Charting System

Job description

Discovery Behavioral Health provided pay range

This range is provided by Discovery Behavioral Health. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$21.00/hr - $23.00/hr

Job Description

Company Description

At Discovery Behavioral Health, we know the best way to predict the future of healthcare is to create it. As a member of our growing team, you will have a voice in the creation of life-changing programs and treatment centers nationwide. Working collaboratively with the best and the brightest in our industry, you will be part of an innovative team of professionals committed to generating positive and remarkable outcomes for the clients we serve.

If you are looking for an organization that thrives on growth, celebrates diversity of thought, and rewards passionate execution, you've come to the right place. Because we put clients first, it is our honor to support and reward those who serve them.

Compensation Range: $21-23 per hour

Compensation will be dependent upon geographic region, education, and experience.

Our Offer to You!

• 401(k)
• Healthcare benefits
• Vacation and sick days
• Employee referral program
• Employee discounts to various stores, amusement parks, events, etc.
• Continuing education (CE) programs and training
• Weekly training opportunities
• Advancement opportunities within the organization

Job Role

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 working 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, including acknowledgment 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 and case details in KIPU chart system and appeal spreadsheet.
• Obtain patient and/or guardian signatures on required payer consent forms.
• Submit retro authorization requests, support retro SCA projects, and follow up on submissions until resolution.
• Identify problem cases and escalate issues to Clinical Appeals Specialist as needed.
• Participate in all monthly UR Team meetings and quarterly Denials meetings.
• Adhere to privacy and HIPAA guidelines.
• Perform or assist with special projects as assigned.

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.
• Proficiency with Zoom and Microsoft Teams for remote meetings.
• Strong skills in Microsoft Office (Excel, Word, Outlook).
• Experience with insurance follow-up, appeals, and grievances.
• Familiarity with medical billing, provider relations, and healthcare office experience.
• Self-starter with strong attention to detail, organizational skills, and excellent communication.
• Flexibility and adaptability to changing situations.
• Excellent customer service and analytical skills.

We encourage applicants who meet some but not all qualifications to apply. Discovery Behavioral Health values diversity and strives for an inclusive environment.

Additional Information

We are an EEO employer M/F/D/V, maintain a drug-free workplace, and perform pre-employment substance testing. All qualified applicants will be considered regardless of age, race, color, religion, sex, or national origin.

For more info on benefits, visit discoverybehavioralhealth.com/careers/

We aim to build a diverse staff reflective of our community and encourage multiple perspectives.