Denials & Appeals RN Administrator

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🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $43 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🖥️ Administration

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Boston Medical Center (BMC)

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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 in addition to Utilization Review • Validate the patient’s placement to the most appropriate level of care • Use medical necessity screening tools to complete reviews • Secure authorization for clinical services through timely collaboration with payers • Follow the UR process, pre-denial and denial/appeal process • Assess, plan, coordinate, and evaluate initial and ongoing denials • Communicate with multiple members of the clinical team in clear concise language • Identify trends and recommend changes to reduce denials

🎯 Requirements

• Requires Bachelor's Degree in Nursing or related field • Licensed to practice professional nursing as a registered nurse in the Commonwealth of Massachusetts • Minimum 5 years of related experience preferably in a 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

🏖️ Benefits

• medical 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