Registered Nurse - Denial Appeal Administrator
November 12
Description
• The RN Appeal Administrator is responsible for the Pre-denial/ Denial and appeal process • Validate the patient’s placement to be at the most appropriate level of care • Use medical necessity screening tools to complete initial and continued stay reviews • Secures authorization for the patient’s clinical services through timely collaboration and communication with payers
Requirements
• Nursing degree: Diploma, ASN or BSN (preferred) • Ability to obtain BSN within 4 years • Licensed to practice as a Registered Nurse in the Commonwealth of Massachusetts • Minimum 5 years or more related experience in a Utilization Management, Denials and Appeals and patient insurance/billing preferred • Work requires a comprehensive knowledge of clinical documentation and medical coding • Knowledge of patient financial billing regulations/requirements, reimbursement, managed care • Work requires advanced interpersonal skills necessary to work with physicians, hospital directors and managers
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