Senior Behavioral Health Appeals Lead (BCBA Preferred)

Elevance Health; Mason (OH); Hybrid; USD 73,000 - 110,000; Full time

Benefits offered by this job

Comprehensive benefits

401(k) matching

Equity stock purchase

Job summary

Elevance Health in Columbus, OH is seeking a Senior Behavioral Health Appeals Coordinator to investigate and process the most complex grievances and appeals from members and providers related to behavioral health services. The role serves as a technical resource to the team and may support medical policy projects.

The position offers hybrid work with in-office 1–2 days per week and requires a licensed behavioral health professional with at least 4 years of healthcare experience.

Qualifications

• MS in social work, RN or related behavioral health degree with 4 years in a managed care/healthcare setting.

Responsibilities

• Investigates and reviews member and provider grievances and appeals.
• Handles complex issues and serves as an internal resource for junior staff.
• Reviews medical records for medical necessity.
• Generates written correspondence to providers, members, and regulatory entities.
• Ensures timely resolution of appeals and grievances within regulatory timeframes.

Education

MS in social work

RN

Licensed Clinical Social Worker (LCSW)

Job description

Elevance Health in Columbus, OH is seeking a Senior Behavioral Health Appeals Coordinator to investigate and process the most complex grievances and appeals from members and providers related to behavioral health services. The role serves as a technical resource to the team and may support medical policy projects.

The position offers hybrid work with in-office 1–2 days per week and requires a licensed behavioral health professional with at least 4 years of healthcare experience.