Denials & Appeals Administrator, RN

Job not on LinkedIn

🔥 0 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $4.3k - $6.3k / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🖥️ Administration

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Boston Medical Center (BMC)

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1996

Boston Medical Center (BMC) is a 511-bed, equity-led academic medical center and a proud member of the Boston Medical Center Health System. BMC delivers a model of healthcare where innovative and equitable care empowers all patients to thrive. As a premier academic medical center in Boston, a national leader in clinical care, and the largest essential hospital in New England, BMC’s world-class clinicians provide comprehensive care in more than 70 specialties and subspecialties.

📋 Description

• Responsible for the Pre-denial/ Denial and appeal process • Validate placement of patients based on admission criteria • Use medical necessity screening tools for reviews • Secure authorization for patient services through collaboration with payers • Assess, plan, coordinate, and evaluate initial and ongoing denials • Research and respond to denials in a timely fashion • Communicate with clinical team members to resolve denials • Identify trends and recommend changes to reduce denials

🎯 Requirements

• Requires Bachelor's Degree in Nursing or related field • Licensed to practice professional nursing in Massachusetts • Minimum 5 years related experience in healthcare case management and patient insurance/billing environment. 3-4 years supervisory experience preferred. • Medical records coding experience is desirable. • Comprehensive knowledge of clinical documentation and medical coding • Working knowledge of patient financial billing regulations/requirements, reimbursement, managed care • Advanced interpersonal skills necessary to work with physicians, hospital directors, and managers

🏖️ Benefits

• Health insurance • Dental insurance • Vision insurance • Pharmacy benefits • Discretionary annual bonuses • Merit increases • Flexible Spending Accounts • 403(b) savings matches • Paid time off • Career advancement opportunities • Resources to support employee and family well-being