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BH Clinical Appeals Reviewer

Company: HCSC
Location: Richardson
Posted on: May 3, 2021

Job Description:

Job ID: KM-1042058


We are the Health Care Management division of HCSC - a team of dedicated nurses, doctors and other clinicians. Everything we do, and every decision we make, aims to help our members live their most healthy lives. We treat the whole person with integrated pharmacy, physical and mental health care benefits.

We're also tackling the social determinants of health by creating non-clinical partnerships in the communities where we work and live, because everyone should have access to quality health care. We use innovative tools and approaches to help members get the most out of their plan benefits, as affordably as possible. We are more than a health care insurer and we are truly anchored in our purpose: to do everything in our power to stand by our members in sickness and in health.

There are 2 openings for this role; this role can be work from home


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, determine appeals decisions or prepare cases for Medical Director review.


* Masters- level Behavioral Health Professional (LPC or LCSW) to practice at the independent practice level with current license in good standing in state of operations. * 4 years clinical experience 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.


* Bilingual in English and Spanish. * Experience in processing appeals, denials or grievances in accordance with regulatory or accreditation requirements. * Experience in Utilization Management or audit * CA


HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.


Expertise Behavioral Health Job Type Full-Time Regular Location OK - Tulsa, MT - Helena, TX - Richardson, IL - Chicago, NM - Albuquerque

Keywords: HCSC, Richardson , BH Clinical Appeals Reviewer, Other , Richardson, Texas

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