Denials & Appeals RN Administrator

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

📋 Description

• Accountable for the Pre-denial/Denial and appeals process, as well as Utilization Review.

• Confirm the patient's placement in the most suitable level of care.

• Employ medical necessity screening tools to conduct reviews.

• Obtain authorization for clinical services through prompt collaboration with payers.

• Adhere to the UR process, including pre-denial and denial/appeal procedures.

• Evaluate, plan, coordinate, and assess initial and ongoing denials.

• Engage with various members of the clinical team using clear and concise communication.

• Detect trends and propose modifications to minimize denials.

⛳️ Requirements

• A Bachelor’s Degree in Nursing or a related discipline is required.

• Must hold a license to practice professional nursing as a registered nurse in the Commonwealth of Massachusetts.

• At least 5 years of relevant experience, preferably in healthcare case management and patient insurance/billing settings.

• Preferred 3-4 years of supervisory experience.

• Experience in medical records coding is advantageous.

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

• Familiarity with patient financial billing regulations and requirements is necessary.

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• Pharmacy benefits

• Discretionary annual bonuses

• Merit increases

• Flexible Spending Accounts

• 403(b) savings matches

• Paid time off

• Opportunities for career advancement

• Resources to support employee and family well-being