RN Denials and Appeals Administrator

Job Summary

A company is looking for a Denials and Appeals Administrator.

Key Responsibilities

• Manage the pre-denial, denial, and appeal processes, ensuring compliance with Utilization Review standards
• Utilize medical necessity screening tools to assess patient care levels and secure authorizations for clinical services
• Collaborate with payers and healthcare staff to facilitate timely communication regarding patient placements and service authorizations

Required Qualifications

• Bachelor's Degree in Nursing or related field; graduate degree preferred
• Minimum of 5 years of related experience in healthcare case management and patient insurance/billing
• 3-4 years of supervisory experience preferred
• Experience in medical records coding is desirable
• Comprehensive knowledge of clinical documentation, medical coding, and patient billing regulations