MANAGED CARE APPEALS REPRESENTATIVE

Managed Care Appeals Representative

Who are we? For over fifty years, Aspire Health Partners has been one of the leading non-profit behavioral health companies in the Southeast. Serving nearly 40,000 clients per year, with locations in six Central Florida counties and currently expanding into Hinesville, Georgia Aspire has delivered state-of-the-art behavioral healthcare and is regularly sought out both statewide and nationally as an expert in the field. With its mission of providing the highest quality of compassionate, comprehensive, and cost effective integrated behavioral healthcare, Aspire, through its more than two dozen campus locations provides a comprehensive continuum of services for children, adolescents, adults, seniors, and families. Through innovative, resourceful treatment and recovery approaches Aspire offers individuals and families the opportunity to "aspire" to healthier, happier, and more independent lives. Aspire employs more than 1,200 professionals and paraprofessionals dedicated to Saving Lives, Transforming Communities and Changing the World

Who You Are: You're a leader looking for an opportunity to define your own career path, connect with a supportive community of health professionals like you, and increase your earning potential. You have a passion for working in different care settings and making a difference in lives.

Job Purpose: As a Managed Care Appeals Representative, you will be responsible for reviewing and resolving insurance claims that have been denied or disputed by insurance carriers for lack of authorization or medical necessity. In addition, you will be responsible for managing and processing medication prior authorizations to ensure timely and efficient medication administration.

Job Functions

• Review and analyze claim denials to perform the appropriate appeals necessary for reimbursement.
• Obtain necessary medical documentation needed for appeal submission.
• Submit written appeals to insurance carriers and follow up on the status of submitted appeals.
• Document and create reports of all appeal activity in appropriate systems and maintain organized records of all appeals.
• Collaborate with Utilization Review and Patient Accounts to resolve any authorization issues.
• Stay current with payor authorization requirements such as time frames.
• Provide excellent customer service to patients, healthcare providers, and insurance carriers.
• Reports to Director of Managed Care and Utilization Review and works closely with to resolve issues.
• Most importantly, all functions must be completed while maintaining high standards of ethical and professional conduct while adhering to agency policies and procedures.

Position qualifications: Ability to receive and maintain a(n)

• A bachelor's degree in a relevant field such as Healthcare, Nursing, Performance, Law, Business, Management or Health. RN or LPN preferred with Behavioral Health experience.
• Ability to receive and maintain a Level II Background clearance.
• Acceptable Motor Vehicle Registration driver's license record in accordance with the underwriting guidelines set by Aspire insurance company as described in the AHP Corporate Transportation Policy 3.9.1
• Ability to multitask, prioritize tasks and meet deadlines.
• Ability to learn and utilize the EHR system.
• Must be able to prioritize workload; plan, organize, and coordinate appropriate workload in conjunction with other team members.
• Have strong analytical/deductive, mathematical analysis and problem-solving skills.
• Ability to work independently and effectively under pressure to meet deadlines.
• Flexible and willing to perform other tasks as assigned.
• 3+ years of experience initiating appeals with Managed Care or Commercial Payors for reimbursement.
• Utilization and/or Case Management experience recommended.
• Proficient in data manipulation and spreadsheet development including pivot tables using Microsoft Excel and other Microsoft Office products.
• Strong communication skills, both verbal and written
• Ability to communicate effectively and professionally, verbally and written, with external/internal clients.
• Strong knowledge of medical terminology, coding systems (ICD-9, ICD-10), and managed care guidelines
• Understand managed care insurance products and their financial impacts on payors and providers.

All the benefits and perks you need for you and your family:

We are committed to providing our employees with the support they need. At Aspire Health Partners, we offer eligible staff an attractive benefit package that includes medical, wellbeing, dental and vision benefits along with some unique benefits including:

• Medical, Dental, Vision, Basic Life & Supplemental Insurance, Flexible Spending & Health Savings Accounts
• Paid Time Off (PTO) (2.5 weeks your first year, up to 6 weeks at 14+ years)
• Paid Diversity & Floating Holidays (2)
• Paid Holidays (6)
• 403(b) 50% employer match up to 10% (3-year vesting cliff)
• Employee Discounts including Tickets, Retail, Hotel, Car Rental/Purchase
• Short-Term & Long-Term Disability Insurance
• HRSA Loan Forgiveness
• Employee Assistance Plan (EAP)
• Will preparation
• Funeral Planning
• Concierge Services & Travel Assistance

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