Behavioral Health Appeals Coordinator Senior (BCBA)

Elevance Health; Oregon; Híbrido; USD 90.000 - 120.000; Jornada completa

Descripción de la vacante

Elevance Health is seeking a Senior Behavioral Health Appeals Coordinator (BCBA) to join our collaborative team in a hybrid arrangement. The role emphasizes complex grievances, medical necessity reviews, and preparing recommendations for appeals, with in-office time 1–2 days weekly.

Candidates will need an MS in social work or related behavioral health field, plus 4+ years in managed care; a current BCBA is preferred.

Formación

• Requires MS in social work, RN or degree in a related behavioral health field, with minimum 4 years in a managed care/healthcare setting.
• Current active unrestricted license as a Licensed Clinical Social Worker, Marriage and Family Therapist, Clinical Psychologist, Licensed Professional Counselor or RN to practice within applicable states.

Responsabilidades

• Investigates and reviews member and provider grievances and appeals.
• Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.
• Prepares recommendations to uphold or deny appeal and forwards to medical director for approval.
• Documents and logs information on tracking systems and mainframe systems.
• Participates in projects impacting development, interpretation, and implementation of medical policy or other managed care initiatives.

Conocimientos

BCBA

Appeals Reviewer

ASD experience

Educación

MS in social work

RN license

Behavioral health degree

Descripción del empleo

Anticipated End Date:2026-11-30

Position Title:Behavioral Health Appeals Coordinator Senior (BCBA)

Job Description:Behavioral Health Appeals Coordinator SeniorHybrid 1

The 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. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

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.

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.

Job Level:

Non-Management Exempt

Workshift:Job Family:MED > Licensed/Certified Behavioral Health Role

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applications that require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.