Tennessee Licensed Market Appeals Specialist

Job Summary

To support utilization management within the behavioral health division, the full-time Tennessee Licensed Market Appeals Specialist will manage and complete standard appeals for both Cerner and non-Cerner facilities remotely, ensuring timely processing and effective communication with local facilities and payers.

Key responsibilities

• Complete all standard appeals timely and manage appeal inventory through ongoing tracking and monitoring
• Act as a liaison with local facilities and payers to ensure timely appeal processing, including appropriate follow-up for facility reimbursement
• Provide feedback to providers and the UM team on opportunities impacting facility recoveries

Required qualifications

• Bachelor's degree required; Master's preferred
• RN License or Master's level clinician required
• 3-5 years of related experience required; 5-8 years preferred
• Knowledge of utilization management operations and experience with appeal letters and payer engagement
• Proficient in Excel, Microsoft Office/Teams, Word, and database inventory management