RN Denial Appeal Administrator

6 days ago

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Boston Medical Center (BMC)

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5001 - 10000

Description

• Responsible for the Pre-denial/ Denial and appeal process • Validate the patient’s placement based on nationally accepted admission criteria • Use medical necessity screening tools for determining appropriate level of patient care • Secure authorization for the patient’s clinical services through timely collaboration with payers • Follow the UR process as defined in the Utilization Review Plan

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 is required • Minimum 5 years or more related experience in a Utilization Management, Denials and Appeals and patient insurance/billing preferred