Remote Market Appeals Specialist - Behavioral Health

Henderson Hospital; Chicago (IL); A distancia; USD 68.000 - 90.000; Jornada completa

Descripción de la vacante

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

Formación

• 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.

Responsabilidades

• 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.

Conocimientos

Utilization management

Excel

Microsoft Office/Teams

Word

Payer engagement

Oral communication

Medical necessity criteria

Clinical acumen

Educación

Bachelor's degree

Master's degree

Herramientas

Excel

Microsoft Office/Teams

Word

Database inventory management

Descripción del empleo

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