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Behav Health Appeals Coord-Virginia Beach 139022 in Virginia Beach, VA at Anthem, Inc.

Date Posted: 2/13/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Job Type:
    Other
  • Experience:
    At least 2 year(s)
  • Date Posted:
    2/13/2018

Job Description

Your Talent. Our Vision. At Anthem Blue Cross, a proud member of the Anthem, Inc. family of companies,  it’s a powerful combination, andthe foundation upon which we’re creating greater access to care for  our members, greater value for our customers,and greater health for our communities. Join us and together we will drivethe future of health care. This is an exceptional opportunity to doinnovative work that means more to you and those we serve. 


This position is responsible for investigating and processing grievances and appeals requests from members and providers related to behavioral health services. Primary duties may include, but are not limited to:

  • Investigates and reviews member and provider grievances and appeals. Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.
  • Extrapolates and summarizes medical information for medical director, consultants and other external review.
  • Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval.
  • Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
  • Documents and logs information on tracking systems and mainframe systems.
  • Generates appropriate written correspondence to providers, members, and regulatory entities.
  • Requires an MS in social work, RN or degree in a related behavioral health field;
  • 2 years of experience in a managed care/healthcare setting; or any combination of education and experience, which would provide an equivalent background. Current active unrestricted license as a Licensed Clinical Social Worker, Marriage and Family Therapist, Clinical Psychologist, Licensed Professional Counselor, or RN license to practice as a health care professional within scope of licensure in applicable state(s) or territory of the United States required.
    EOE.M/F/Disability/Veteran

Job Requirements

Requirements

  • an MS in social work, RN diploma or degree in a related behavioral health field;
  • 2 years of experience in a managed care/healthcare setting;
  • or any combination of education and experience, which would provide an equivalent background.
  • Current active unrestricted license as a Licensed Clinical Social Worker, Marriage and Family Therapist, Clinical Psychologist, Licensed Professional Counselor, or RN license to practice as a health care professional within scope of licensure in applicable state(s) or territory of the United States required.

Anthem, Inc. is ranked as one ofAmerica’s Most Admired Companies among health insurers by Fortune magazine andis a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn moreabout our company and apply, please visit us at antheminc.com/careers. EOE.M/F/Disability/Veteran.