Massachusetts Licensed Denials Administrator

Job Summary

Working remotely in a full-time capacity, the Massachusetts Licensed Denials Administrator will manage the pre-denial, denial, and appeal processes while conducting utilization reviews to ensure appropriate patient care levels and secure authorizations for clinical services.

Key responsibilities

• Oversee the denial and appeal processes, including research and response to clinical denials
• Collaborate with clinical teams and payers to resolve denials and recommend changes to reduce trends
• Analyze and report data related to denials to the Director of Care Management for review

Required qualifications

• Bachelor's Degree in Nursing or a related field; graduate degree preferred
• Current Massachusetts RN license required
• Minimum of 5 years of relevant experience in healthcare case management and patient insurance/billing
• 3-4 years of supervisory experience preferred
• Knowledge of medical records coding and patient financial billing regulations is desirable