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Regional Appeals Specialist

Universal Health Services
United States, Pennsylvania, Philadelphia
Apr 29, 2025
Responsibilities

Position Summary: The Regional Appeals Specialist supports utilization management shared services within the behavioral health division. This role oversees and completes all standard appeals within a designated market, including both Cerner and non-Cerner facilities. Responsibilities include:

  • Timely completion of standard appeal letters.
  • Utilizing medical records to accurately present the clinical status of patients to support the requested level of care.
  • Appropriate and timely follow-up with payers for facility reimbursement.
  • Tracking and monitoring all standard appeal inventory.
  • Attending facility meetings as needed.
  • Supporting ongoing partnerships with facilities to optimize payment reimbursement through appeals.

Qualifications

Qualifications:

  • RN or master's level clinician required.
  • 3-5 years of experience in utilization management operations, including experience with appeal letters and payer engagement.
  • Knowledge of payer requirements for reimbursement across all levels of care.
  • Understanding of medical necessity criteria application for all levels of care.

Licensure/Certification:

  • Independent licensure in your respective healthcare degree preferred, but not required.

Specialized Skills/Knowledge:

  • Proficiency in Excel, Microsoft Office/Teams, Word, and database inventory management.
  • Strong written and oral communication skills to represent patient progress and treatment in behavioral health.
  • Ability to apply clinical acumen in behavioral health to written correspondence.
  • Capability to work independently in a multifaceted, fast-paced environment with dependencies on local facility teams.
  • Knowledge of behavioral health business office operations.

Essential Job Duties and Responsibilities:

  • Participate in local facility UM team meetings to support the standard appeal process (15%).
  • Complete all standard appeals timely and manage appeal inventory (50%).
  • Provide feedback to providers and UM team on opportunities impacting facility recoveries (e.g., documentation) (10%).
  • Act as a liaison with local facilities and payers to ensure timely appeal processing (20%).
  • Perform other duties as assigned (5%).

About Universal Health Services

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $13.4 billion in 2022. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 94,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. states, Washington, D.C., Puerto Rico and the United Kingdom.

www.uhs.com

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.

Notice

At UHS and all subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates with matching skillset and experience with the best possible career at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail etc. If you feel suspicious of a job posting or job-related email, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449

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