REGIONAL APPEALS SPECIALIST

Fort Lauderdale Behavioral Health is a 182-bed treatment facility that specializes in quality behavioral health and substance abuse services for youth, adults and seniors. We offer a full continuum of care through an integrated system of inpatient, residential, partial hospitalization and intensive outpatient programs. Progressive professionals in the fields of psychiatry, medicine, nursing, social services, education and activity therapy provide our comprehensive services. www.ftlauderdalebehavioral.com

Regional Appeals Specialist

Position Summary: The Regional Appeals Specialist supports utilization management shared services within the behavioral health division. This role oversees and completes all standard appeals within a designated market, including both Cerner and non-Cerner facilities. Responsibilities include:

• Timely completion of standard appeal letters.
• Utilizing medical records to accurately present the clinical status of patients to support the requested level of care.
• Appropriate and timely follow-up with payers for facility reimbursement.
• Tracking and monitoring all standard appeal inventory.
• Attending facility meetings as needed.
• Supporting ongoing partnerships with facilities to optimize payment reimbursement through appeals.

Universal Health Services, Inc. (UHS) knows what it takes to lead, inspire and succeed. One of the Nation's largest and most respected hospital companies, UHS owns and operates through its subsidiaries acute care hospitals, behavioral health facilities and ambulatory centers in the United States, Puerto Rico, the U.S. Virgin Islands and the United Kingdom. Headquartered in King of Prussia, PA, UHS ranks on the Fortune 500 list of America's largest corporations with over 90,000 employees, and is consistently listed among Fortune's "Most Admired Companies" and one of the 30 Most Meaningful Companies To Work For in America by Business Insider.

Qualifications:

• RN or master's level clinician required.
• 3-5 years of experience in utilization management operations, including experience with appeal letters and payer engagement.
• Knowledge of payer requirements for reimbursement across all levels of care.
• Understanding of medical necessity criteria application for all levels of care.

Licensure/Certification:

• Independent licensure in your respective healthcare degree preferred, but not required.

Specialized Skills/Knowledge:

• Proficiency in Excel, Microsoft Office/Teams, Word, and database inventory management.
• Strong written and oral communication skills to represent patient progress and treatment in behavioral health.
• Ability to apply clinical acumen in behavioral health to written correspondence.
• Capability to work independently in a multifaceted, fast-paced environment with dependencies on local facility teams.
• Knowledge of behavioral health business office operations.

Essential Job Duties and Responsibilities:

• Participate in local facility UM team meetings to support the standard appeal process (15%).
• Complete all standard appeals timely and manage appeal inventory (50%).
• Provide feedback to providers and UM team on opportunities impacting facility recoveries (e.g., documentation) (10%).
• Act as a liaison with local facilities and payers to ensure timely appeal processing (20%).
• Perform other duties as assigned (5%).

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449