Appeals Coordinator
New Directions Behavioral Health
 Shawnee Mission, KS

Join one of the fastest-growing behavioral healthcare companies in the industry!!

Founded in 1995, New Directions helps people live healthy, balanced lives. New Directions provides managed behavioral health services, an Employee Assistance Program, Student Assistance Program, organizational consulting and health coaching to private and public health plans, Fortune 100 companies, large and medium employers and labor groups.

Role and Responsibilities:

  • Appropriate processing and documentation of appeals, including issuing compliant notices
  • Monitor time standards and assist clinical reviewers with adherence to timeframes
  • Work closely with the management staff supporting appeals and claims
  • Communicates detailed account of risk management issues to appeals leadership within the specified timeframe
  • Appeals and claims research and basic understanding of claims business rules
  • Ensure compliance with HIPAA regulations, to include confidentiality and appropriate authorization is on file, e.g. appointed representative, signed release of information, etc.
  • Work closely with customer service and reimbursement staff related to member and provider appeals inquiries
  • Demonstrates flexibility with a willingness to learn and adapt to changes in regulations and task-related priorities

Accountable for the following end results:

  • Meets productivity standards for completion of assigned appeal files, with 95% accuracy and timeliness of completed appeals
  • Adheres to New Directions Behavioral Health Mission Statement, Core Values, Code of Business Conduct, and Compliance Program
  • Complies with all Federal and applicable State laws and New Directions Behavioral Health Policies regarding, privacy, confidentiality, and security of health information, and other designated information

Qualified candidates will have:

  • Some college with 1 year of experience in a healthcare-related environment
  • Appeals experience minimum 1 year OR a high school diploma and 2 or more years of experience in a healthcare environment
  • Professional demeanor and work collaboratively with multiple levels of professionals, management and line staff
  • Highly organized and detail-oriented
  • Basic knowledge of Microsoft Office (Word, Excel, Outlook)
  • Adaptable to various software programs
  • Strong written and oral communication skills
  • Knowledge of medical terminology

Preferred

  • Bachelor's degree or some college with 2 or more years of experience in a healthcare or managed care environment
  • Appeals experience 1 or more years OR a high school diploma and 2 or more years of experience in a healthcare-related environment
  • Experience applying accreditation and regulatory requirements and ensuring ongoing compliance
  • Knowledge of Medicare and Medicaid
  • Knowledge of the managed care industry