RN Appeals Administrator

A company is looking for a Denials and Appeals Administrator.

Key Responsibilities

Manage the pre-denial, denial, and appeal processes, ensuring compliance with nationally accepted admission criteria

Utilize medical necessity screening tools to conduct initial and continued stay reviews for patient care appropriateness

Secure authorization for clinical services through collaboration with payers and adherence to the Utilization Review Plan

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 financial billing regulations