Massachusetts Licensed RN Administrator

Job Summary

Responsible for managing the pre-denial and appeal process, the full-time Denials & Appeals RN Administrator will validate patient placements, secure authorizations, and collaborate with clinical teams to reduce denial trends while working remotely.

Key responsibilities

• Oversee the pre-denial and denial/appeal processes in accordance with established guidelines
• Collaborate with clinical teams and payers to resolve clinical denials and secure authorizations for services
• Analyze denial trends and recommend changes to improve documentation and reduce financial risk

Required qualifications

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