Behavioral Health Appeals Coordinator Senior (BCBA)
Core
Investigates and processes complex grievances and appeals for behavioral health services, reviewing medical records for medical necessity and preparing recommendations for denial or upholding appeals.
Role type
Senior Licensed Behavioral Health Appeals Coordinator
Builds
Medical policy initiatives and managed care processes
Domain
Healthcare / Managed Care / Behavioral Health
Deliverable
dashboards & analysis
Required skills
Medical record review, Medical necessity determination, Grievance investigation, Regulatory compliance, Policy interpretation, Clinical documentation
Preferred skills
Board Certified Behavior Analyst (BCBA), Appeals reviewer experience, Autism spectrum disorder (ASD) expertise
Technologies
Tracking systems, Mainframe systems
Responsibilities
Review prospective, inpatient, or retrospective medical records for denied services; Extrapolate and summarize medical information for external review; Prepare recommendations to uphold or deny appeals; Ensure timely resolution of appeals and grievances; Document and log information on tracking systems; Generate written correspondence to providers and regulatory entities.
Seniority
Senior, Licensed/Certified