Registered Nurse Denials Appeals Administrator
Company: VirtualVocations
Location: Hartford
Posted on: November 7, 2024
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Job Description:
A company is looking for a Registered Nurse Denials & Appeals
Administrator to manage the pre-denial and appeal processes.
Key Responsibilities
Oversee the pre-denial, denial, and appeal processes, ensuring
compliance with Utilization Review standards
Utilize medical necessity screening tools to validate patient
placement and appropriateness of care
Collaborate with payers to secure authorization for clinical
services and manage continued stay reviews
Required Qualifications
Associate's degree in Nursing required; Bachelor's degree
preferred
Minimum of 5 years of experience in Utilization Management, Denials
and Appeals, or patient insurance/billing
Comprehensive knowledge of clinical documentation, medical coding,
and patient financial billing regulations
Experience in Case Management and HMO settings is preferred
Understanding of medical records coding and health insurance
standards
Keywords: VirtualVocations, Providence , Registered Nurse Denials Appeals Administrator, Healthcare , Hartford, Rhode Island
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