Behavioral Health Appeals Coordinator Senior BCBA

ANTHEM INSURANCE COMPANIES INC; Atlanta (GA); Hybrid; USD 73,000 - 110,000; Full time

Job summary

Elevance Health in Columbus, OH and Virginia is seeking a Behavioral Health Appeals Coordinator Senior. The role investigates complex grievances and appeals from members and providers, and may support medical policy projects.

It requires a graduate degree in social work or related field and a clinical license, with 1–2 days in-office weekly to foster collaboration. Preferred BCBA and prior appeals reviewer experience are beneficial.

Qualifications

• MS in social work, RN or related behavioral health degree with 4 years in managed care/healthcare.
• Active unrestricted license (LCSW, LMFT, Psychologist, LPC) or RN in applicable state(s).
• Licensure scope must be within state regulations; relevant behavioral health background required.

Responsibilities

• Investigates and processes the most complex behavioral health grievances and appeals.
• Acts as an internal resource for lower-level coordinators and staff.
• Reviews medical records for medical necessity; summarizes information for medical directors.
• Prepares recommendations to uphold or deny appeals; forwards for approval.
• Ensures timely resolution to meet regulatory timeframes.
• Documents tracking system activity and generates written correspondence.

Skills

BCBA

Appeals reviewer

ASD experience

Education

MS in social work

RN

Behavioral health degree

Job description

Behavioral Health Appeals Coordinator Senior

This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance.

This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Alternate locations may be considered if candidates reside within a commuting distance from an office.

The Behavioral Health Appeals Coordinator Senior is responsible for investigating and processing the most complex grievances and appeals requests from members and providers related to behavioral health services.

Serves as a technical resource to team and may be assigned to work on projects in support of medical policy and/or managed care initiatives.

How you will make an impact:

• Investigates and reviews member and provider grievances and appeals.
• Generally, works on issues that are of a complex nature.
• Serves as an internal resource for lower-level behavioral health appeal coordinators and staff.
• Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.
• Extrapolates and summarizes medical information for medical director, consultants and other external review.
• Prepares recommendations to either uphold or deny appeal and forwards to medical director for approval.
• Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
• Documents and logs information on tracking systems and mainframe systems.
• Generates appropriate written correspondence to providers, members, and regulatory entities.
• Participates in projects impacting development, interpretation, and implementation of medical policy or other managed care initiatives.

Minimum requirements:

• Requires MS in social work, RN or degree in a related behavioral health field and minimum of 4 years of experience in a managed care/healthcare setting; or any combination of education and experience, which would provide an equivalent background.

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 health care professional within scope of licensure in applicable state(s) or territory of the United States required.

Preferred Skills, Capabilities and Experiences

• Board Certified Behavior Analyst (BCBA) strongly preferred.
• Experience as an Appeals Reviewer highly preferred.
• Specialized background working with individuals diagnosed with autism spectrum disorder (ASD) preferred.

For candidates working in person or virtually in the below locations, the salary

• range for this specific position is $73,280 to $109,920

Location

Columbus, OH & Virginia.

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.

The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting.

This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.

Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations.

No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans.

The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.