Massachusetts RN Denials Administrator

Job Summary

A company is looking for an RN Denials and Appeals Administrator, Per Diem.

Key Responsibilities

• Manage the pre-denial, denial, and appeal processes, ensuring compliance with Utilization Review standards
• Utilize medical necessity screening tools to validate patient care levels and secure authorization for clinical services
• Collaborate with payers to facilitate timely communication regarding patient care and authorization needs

Required Qualifications

• Associate or Bachelor Degree in Nursing; graduate degree preferred
• MA RN License required; CCM or ACM certification preferred
• 3-5 years of experience in healthcare case management and patient insurance/billing
• Ability to obtain a BSN within 4 years
• Preferred 3-4 years of supervisory experience