Tennessee Licensed Market Appeals Specialist 3091282 I.Html

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