Rhode Island Licensed Denials Manager

Job Summary

A company is looking for a Manager of Denials Management.

Key Responsibilities

• Manage and coordinate the review of denied claims and the appeals process
• Collaborate with various departments to ensure compliance with utilization standards and documentation improvement
• Track the status of denials and appeals while providing education and support to staff regarding denial prevention

Required Qualifications

• Bachelor's degree in Business, Healthcare, or related field
• Active RN nursing licensure in state of residence
• Five to seven years of experience in healthcare with emphasis on financial operations and managed care policies
• Knowledge of hospital/professional billing, Medicare and Medicaid denials, and appeals
• Experience with statistical analysis and financial reporting