Behavioral Health Appeals Coordinator Senior (BCBA & Ohio BH Licensed)

Elevance Health; United States; Híbrido; USD 73 000 - 110 000; Tempo integral

Resumo da oferta

Elevance Health is seeking a Behavioral Health Appeals Coordinator Senior (BCBA & Ohio BH Licensed) in Ohio. This role handles complex grievances and appeals from members and providers, serving as a technical resource for the team.

You will review medical records for medical necessity, prepare recommendations for medical director approval, and ensure timely resolution within regulatory timeframes. The position offers hybrid/virtual options with required in-person training sessions.

Qualificações

• Requires MS in social work, RN or degree in a related behavioral health field with license.
• Active, unrestricted license to practice in applicable state(s) or territory.
• 4+ years in a managed care/healthcare setting or equivalent background.

Responsabilidades

• Investigates and reviews member and provider grievances and appeals.
• Reviews medical records for medical necessity.
• Prepares recommendations and forwards to medical director for approval.
• Ensures timely resolution to meet regulatory timeframes.
• Documents information on tracking systems and mainframe systems.
• Participates in projects impacting medical policy or managed care initiatives.

Conhecimentos

BCBA

Appeals Reviewer

ASD experience

Formação académica

MS in social work / RN or related behavioral health field

Descrição da oferta de emprego

Anticipated End Date:

2026-11-30

Position Title:

Behavioral Health Appeals Coordinator Senior (BCBA & Ohio BH Licensed)

Job Description:

Behavioral Health Appeals Coordinator Senior

Location: Ohio only

Virtual : This role enables associates to workvirtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.Alternate locations may be considered if candidatesresidewithin 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.

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

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

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

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. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. 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.

NOTE:

Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.