Senior Behavioral Health Appeals Coordinator, BCBA, Ohio BH Licensed

Elevance Health

. Investigate and review member and provider grievances and appeals .

Posted 10/22/2026full-timeRemote • Ohio • United StatesSenior💰 $73,280 - $109,920 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in investigating and resolving member and provider grievances and appeals within behavioral health, ensuring compliance with regulatory timeframes. Proficient in reviewing medical records for medical necessity and generating correspondence for various stakeholders.

Highest-signal resume keywords

Licensed Clinical Social WorkerBehavioral Health Appeals ReviewMedical Necessity ReviewBoard Certified Behavior AnalystExperience with Autism Spectrum Disorder

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Grievance InvestigationMedical Record ReviewAppeals PreparationDocumentation and LoggingMedical Policy Implementation

Soft Skills

CommunicationCollaborationProblem-Solving

Tools & Technologies

Tracking SystemsMainframe Systems

Certifications & Qualifications

Licensed Clinical Social WorkerRegistered Nurse LicenseBoard Certified Behavior Analyst

Industry Keywords

Managed CareBehavioral HealthHealthcare SettingRegulatory ComplianceAutism Spectrum Disorder

About the role

Key responsibilities & impact

Investigate and review member and provider grievances and appeals
Work on complex behavioral health issues
Serve as an internal resource for lower-level behavioral health appeal coordinators and staff
Review prospective, inpatient, or retrospective medical records of denied services for medical necessity
Extrapolate and summarize medical information for medical directors, consultants, and other external review
Prepare recommendations to uphold or deny appeals and forward them to the medical director for approval
Ensure appeals and grievances are resolved timely to meet regulatory timeframes
Document and log information on tracking systems and mainframe systems
Generate written correspondence to providers, members, and regulatory entities
Participate in projects supporting development, interpretation, and implementation of medical policy and managed care initiatives

Requirements

What you’ll need

MS in social work, RN or degree in a related behavioral health field, and minimum of 4 years of experience in a managed care/healthcare setting; or any combination of education and experience providing 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
Ohio residence/location eligibility
Must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
Board Certified Behavior Analyst (BCBA) strongly preferred
Experience as an Appeals Reviewer highly preferred
Specialized background working with individuals diagnosed with autism spectrum disorder (ASD) preferred

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short and long term disability benefits
401(k) + match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Virtual full-time work arrangement, except for required in-person training sessions
COVID-19 and Influenza vaccination support/requirement for certain patient/member-facing roles