APPEALS SPECIALIST

Universal Health Services (UHS) is a Fortune 500 company operating hospitals, behavioral health facilities, outpatient facilities, and more across the United States and other locations. Position Summary This position is responsible for monitoring insurance denials, running relevant reports, and documenting appeal results in MS4 and MIDAS. The individual oversees staff handling post-discharge provider authorization disputes and “take-backs” related to clinical authorization and closed chart denials. The role requires coordination with HIM to retrieve charts, collaboration with facility clinicians to obtain missing information, and managing denials and appeals for designated facilities within FRN. Essential Duties and Responsibilities Monitors insurance denials by running appropriate reports and documents results in MS4 and MIDAS, including notifications to providers and members. Manages staff responsible for all post‑discharge provider authorization disputes and “take‑backs” caused by clinical authorization and closed chart denial appeals. Works with HIM to retrieve charts and with facility clinicians to obtain missing information in a timely manner, ensuring the best possible appeal case. Resolves issues associated with appeals between internal departments of the BO or external departments of the facilities served. Manages caseload and is responsible for all post‑discharge provider authorization disputes and “take‑backs” due to clinical authorization and closed chart denial appeals on their caseload. Benefits Challenging and rewarding work environment. Growth and development opportunities within UHS and its subsidiaries. Competitive compensation. Excellent medical, dental, vision and prescription drug plan. 401(k) plan with company match. Generous paid time off. Qualifications High School Graduate/GED required; Associate’s Degree preferred. 1–3 years of related work experience. Excellent verbal and written communication skills. Solid clinical background in providing substance abuse and/or mental health treatment. Familiarity with the utilization process involved in working with health plans. Proficiency in Microsoft Suite for word processing, spreadsheets, and presentations. Good understanding of dual diagnosis treatment. 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. #J-18808-Ljbffr