Tennessee Licensed Market Appeals Specialist

Job Summary

To support utilization management within the behavioral health division, the full-time remote Tennessee Licensed Market Appeals Specialist will oversee and complete all standard appeals, manage appeal inventory, and act as a liaison with local facilities and payers to ensure timely processing.

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 and appropriate follow-up for facility reimbursement
• Participate in local facility UM team meetings to support the standard appeal process and provide feedback on documentation impacting facility recoveries

Required qualifications

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