Denials & Appeals Administrator, RN

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Oversee the pre-denial, denial, and appeal processes.

• Verify patient placements in accordance with admission criteria.

• Utilize medical necessity screening tools for evaluations.

• Obtain authorization for patient services by collaborating with payers.

• Evaluate, plan, and coordinate both initial and ongoing denial assessments.

• Investigate and respond to denials promptly.

• Liaise with clinical team members to address and resolve denials.

• Detect patterns and propose modifications to minimize denials.

⛳️ Requirements

• A Bachelor's Degree in Nursing or a related field is required.

• Must be licensed to practice professional nursing in Massachusetts.

• At least 5 years of relevant experience in healthcare case management and patient insurance/billing settings, with 3-4 years of supervisory experience preferred.

• Experience in medical records coding is an advantage.

• In-depth understanding of clinical documentation and medical coding is essential.

• Familiarity with patient financial billing regulations, reimbursement processes, and managed care is necessary.

• Strong interpersonal skills are required to effectively collaborate with physicians, hospital directors, and managers.

🏝️ Benefits

• Health insurance coverage.

• Dental insurance plans.

• Vision insurance options.

• Pharmacy benefits available.

• Annual discretionary bonuses.

• Opportunities for merit increases.

• Flexible Spending Accounts offered.

• 403(b) savings matches provided.

• Paid time off benefits.

• Career advancement opportunities available.

• Resources to support the well-being of employees and their families.