MARKET APPEALS SPECIALIST- CENTRAL APPEALS OFFICE

Talentify; Chicago (IL); Remote; USD 68,000 - 90,000; Full time

Job summary

Universal Health Services (UHS) invites applications for a Market Appeals Specialist to support utilization management and the Central Appeals Office. The role handles standard appeals across Cerner and non-Cerner facilities, requiring strong clinical acumen and payer liaison skills in a fully remote environment.

Ideal candidates will have a Bachelor's degree (Master's preferred), RN or clinical master's, and 3–5+ years in utilization management with proficiency in Excel, Word, and database

Qualifications

• Bachelor's degree required; Master's preferred.
• RN License or Master's level clinician required; Licenusre preferred.
• 3-5 years related experience required; 5-8 preferred.
• Knowledge of utilization management operations, including experience with appeal letters and payer engagement.
• Proficient in Excel, Microsoft Office/Teams, Word, and database inventory management.
• Knowledge of payer requirements for reimbursement across all levels of care and behavioral health business office operations.
• Strong oral communication skills to represent patient progress and treatment in behavioral health.
• Understanding of medical necessity criteria application for all levels of care.
• Ability to apply clinical acumen in behavioral health to written correspondence.

Responsibilities

• Complete all standard appeals timely and manage appeal inventory through ongoing tracking and monitoring.
• Act as a liaison with local facilities and payers to ensure timely appeal processing including appropriate follow-up with payers for facility reimbursement.
• Participate in local facility UM team meetings to support the standard appeal process.
• Provide feedback to providers and UM team on opportunities impacting facility recoveries (e.g., documentation).
• Performs other duties as assigned/required by this position.

Skills

Utilization management

Excel

Microsoft Office/Teams

Word

Payer engagement

Oral communication

Medical necessity criteria

Clinical acumen

Education

Bachelor's degree

Master's degree

Tools

Excel

Microsoft Office/Teams

Word

Database inventory management

Job description

Responsibilities

BH Shared Services (a UHS company) is currently seeking an experienced Market Appeals Specialist to join our established team in the Central Appeals Office.

POSITION SUMMARY:

Market Appeals Specialist This position supports utilization management and shared services within the behavioral health division. This role oversees and completes all standard appeals within a designated market, including both Cerner and non-Cerner facilities.
A successful candidate must have knowledge of utilization management operations, including experience with appeal letters and payer engagement. The ability to apply clinical acumen in a behavioral health setting both verbally and in writing is essential to this role. *This is a fully remote position.

RESPONSIBILITIES:

• Complete all standard appeals timely and manage appeal inventory through ongoing tracking and monitoring.
• Act as a liaison with local facilities and payers to ensure timely appeal processing including appropriate follow-up with payers for facility reimbursement.
• Participate in local facility UM team meetings to support the standard appeal process.
• Provide feedback to providers and UM team on opportunities impacting facility recoveries (e.g., documentation)
• Performs other duties as assigned/required by this position

This opportunity provides the following:

• UHS offers a challenging and rewarding work environment
• Growth and development opportunities within UHS and its subsidiaries
• Competitive Compensation
• Excellent Medical, Dental, Vision and Prescription Drug Plan.
• 401k plan with company match
• Generous Paid Time Off

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $15.8 billion in 2024. UHS was again recognized as one of the World’s Most Admired Companies by Fortune; listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points,

an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications

REQUIREMENTS:

• Bachelor's degree required, Master's preferred
• RN License or Master's level clinician required,Licenusre preferred
• 3-5 years related experience required, 5-8 preferred
• Knowledge of utilization management operations, including experience with appeal letters and payer engagement.
• Proficient in Excel, Microsoft Office/Teams, Word, and database inventory management.
• Knowledge of payer requirements for reimbursement across all levels of care and behavioral health business office operations.
• Strong oral communication skills to represent patient progress and treatment in behavioral health.
• Understanding of medical necessity criteria application for all levels of care.
• Ability to apply clinical acumen in behavioral health to written correspondence.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

Avoid and Report Recruitment Scams

We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.