Massachusetts RN Appeals Administrator
Company: VirtualVocations
Location: Pasadena
Posted on: February 11, 2025
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Job Description:
A company is looking for an RN Denials and Appeals
Administrator, Per Diem.
Key Responsibilities
Manage the pre-denial, denial, and appeal processes, ensuring
compliance with Utilization Review standards
Utilize medical necessity screening tools for initial and continued
stay reviews to determine appropriate patient care levels
Collaborate with payers to secure authorization for clinical
services in a timely manner
Required Qualifications, Training, and Education
Nursing degree: Diploma, ASN, or BSN (preferred), with the ability
to obtain a BSN within 4 years
MA RN License required; CCM or ACM certification preferred
3-5 years of related experience in healthcare case management and
patient insurance/billing
Preferred 3-4 years of supervisory experience
Comprehensive knowledge of clinical documentation, medical coding,
and patient financial billing regulations
Keywords: VirtualVocations, Pasadena , Massachusetts RN Appeals Administrator, Healthcare , Pasadena, California
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