What are the responsibilities and job description for the Behavioral Health Clinical Appeals Reviewer position at Health Care Service Corporation?
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Job Summary
This position is responsible for coordinating clinical appeals / grievances and complaints for Behavioral Health, reporting, monitoring, scheduling and facilitating appeals according to various regulatory requirements. Analyzes appeals data, determines appeals decisions or prepare cases for Medical Director review.
Job Requirements :
- Registered Nurse (RN) or Masters-level Behavioral Health Professional (LPC, LMFT, LCSW, LCPC) with current license to practice at the independent practice level.
- 4 years clinical experience (post licensure at the independent practice level) to include implementing or administering managed care or quality assurance activities.
- Knowledge and understanding of state and federal guidelines and regulations.
- Written and verbal communication skills and facilitating skills.
- Interpersonal skills to interface with internal and external customers, including representative of Department of Insurance and government agencies in a rapport-developing manner.
- Organizational skills.
- Detail oriented.
Preferred Job Requirements :
LI-Remote
This is a Telecommute (Remote) role for TX, OK, NM, MT and IL : Must reside anywhere within the posted State(s).
Work Schedule : Work Hours are Monday through Friday 8 : 30 AM to 5 : 30 PM (Time Zone aligned)
Sponsorship is not available.
The Compensation / Salary offered for this Position will vary depending on Job-related skills, education, knowledge and experience. This role aligns with an Annual Performance Incentive (Bonus) plan.
We encourage people of all backgrounds and experiences to apply.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
Pay Transparency Statement :
At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
HCSC Employment Statement :
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Base Pay Range
60,300.00 - $133,400.00
Salary : $60,300 - $133,400
