Senior Behavioral Health Appeals Coordinator, BCBA, Ohio BH Licensed

Job not on LinkedIn

🔥 1 hour ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $73.3k - $109.9k / year

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Investigate and review member and provider grievances and appeals • Work on complex behavioral health issues • Serve as an internal resource for lower-level behavioral health appeal coordinators and staff • Review prospective, inpatient, or retrospective medical records of denied services for medical necessity • Extrapolate and summarize medical information for medical directors, consultants, and other external review • Prepare recommendations to uphold or deny appeals and forward them to the medical director for approval • Ensure appeals and grievances are resolved timely to meet regulatory timeframes • Document and log information on tracking systems and mainframe systems • Generate written correspondence to providers, members, and regulatory entities • Participate in projects supporting development, interpretation, and implementation of medical policy and managed care initiatives

🎯 Requirements

• 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 providing 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 • Ohio residence/location eligibility • Must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law • 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

🏖️ Benefits

• Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short and long term disability benefits • 401(k) + match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Virtual full-time work arrangement, except for required in-person training sessions • COVID-19 and Influenza vaccination support/requirement for certain patient/member-facing roles