Coordinator, Appeals
Lifepoint Health®, Louisville, KY, United States
Summary
The Appeals Coordinator gathers all information required for an appeal, writes and submits appeals to insurance companies, performs follow-up, and maintains detailed documentation. This role utilizes clinical criteria guidelines and documentation to develop well-supported appeal arguments that demonstrate medical necessity, working both independently and collaboratively to support positive clinical and financial outcomes.
Essential Functions
Gather all necessary documentation required for insurance appeals
Write, prepare, and submit appeals to insurance companies in accordance with payer requirements
Perform follow-up phone calls and status checks on submitted appeals
Maintain accurate and detailed documentation of all appeal activities
Apply clinical criteria guidelines to support medical necessity for inpatient and outpatient services
Verify payer‑specific appeal requirements including submission methods and timelines
Manage large volumes of documents including copying, faxing, and scanning incoming materials
Document and track appeal activity within tracking systems and mainframe systems
Ensure appeals are completed accurately and within required timeframes
Interface with managed care organizations, external reviewers, and other payers
Access and utilize provider portals for appeal submission and follow‑up
Collaborate with Utilization Review (UR) staff and other departments to complete the appeal process efficiently
Knowledge, Skills and Abilities
Strong critical‑thinking skills and decisive judgment
Ability to work independently with minimal supervision
Ability to function effectively in a fast‑paced, potentially stressful environment
Strong attention to detail and accuracy in financial transactions
Effective communication and problem‑solving skills
Ability to manage multiple tasks and meet deadlines
Education & Experience
Requires Bachelor’s Degree in social work, RN, or a related behavioral health field and a minimum of two years of experience in a managed‑care/healthcare setting; or an equivalent combination of education and experience.
Experience
Previous utilization‑review experience in a psychiatric healthcare facility is preferred.
Additional Requirements
Computer proficiency in Microsoft Office applications and other software programs essential to perform job functions
May be required to work flexible hours and overtime
Reports to
Business office Supervisor
EEOC Statement
Springstone is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans’ status or any other basis protected by applicable federal, state or local law.
Pay Transparency Notice (Washington State)
If you believe this job posting does not include accurate or complete pay information in accordance with the Washington State Equal Pay and Opportunities Act, please inform us immediately. You can contact us at 833-271-4269 to report the issue. For more information on your rights under Washington’s pay transparency laws, visit https://lni.wa.gov.
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The Appeals Coordinator gathers all information required for an appeal, writes and submits appeals to insurance companies, performs follow-up, and maintains detailed documentation. This role utilizes clinical criteria guidelines and documentation to develop well-supported appeal arguments that demonstrate medical necessity, working both independently and collaboratively to support positive clinical and financial outcomes.
Essential Functions
Gather all necessary documentation required for insurance appeals
Write, prepare, and submit appeals to insurance companies in accordance with payer requirements
Perform follow-up phone calls and status checks on submitted appeals
Maintain accurate and detailed documentation of all appeal activities
Apply clinical criteria guidelines to support medical necessity for inpatient and outpatient services
Verify payer‑specific appeal requirements including submission methods and timelines
Manage large volumes of documents including copying, faxing, and scanning incoming materials
Document and track appeal activity within tracking systems and mainframe systems
Ensure appeals are completed accurately and within required timeframes
Interface with managed care organizations, external reviewers, and other payers
Access and utilize provider portals for appeal submission and follow‑up
Collaborate with Utilization Review (UR) staff and other departments to complete the appeal process efficiently
Knowledge, Skills and Abilities
Strong critical‑thinking skills and decisive judgment
Ability to work independently with minimal supervision
Ability to function effectively in a fast‑paced, potentially stressful environment
Strong attention to detail and accuracy in financial transactions
Effective communication and problem‑solving skills
Ability to manage multiple tasks and meet deadlines
Education & Experience
Requires Bachelor’s Degree in social work, RN, or a related behavioral health field and a minimum of two years of experience in a managed‑care/healthcare setting; or an equivalent combination of education and experience.
Experience
Previous utilization‑review experience in a psychiatric healthcare facility is preferred.
Additional Requirements
Computer proficiency in Microsoft Office applications and other software programs essential to perform job functions
May be required to work flexible hours and overtime
Reports to
Business office Supervisor
EEOC Statement
Springstone is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans’ status or any other basis protected by applicable federal, state or local law.
Pay Transparency Notice (Washington State)
If you believe this job posting does not include accurate or complete pay information in accordance with the Washington State Equal Pay and Opportunities Act, please inform us immediately. You can contact us at 833-271-4269 to report the issue. For more information on your rights under Washington’s pay transparency laws, visit https://lni.wa.gov.
#J-18808-Ljbffr