Denials and Appeals Administrator
Employment Information
Job Description
RN Appeal Administrator responsible for pre-denial/appeal process and Utilization Review. Validates patient care levels through medical necessity tools and secures payer authorizations.
Responsibilities:
- Responsible for the Pre-denial/ Denial and appeal process
- Use medical necessity screening tools like InterQual or MCG criteria
- Complete initial and continued stay reviews
- Determine appropriate level of patient care
- Secure authorization for clinical services through collaboration with payers
- Follow the UR process and assist with the pre-denial and denial/appeal process
Requirements:
- Requires Bachelor's Degree in Nursing or related field
- Minimum 5 years or more related experience preferably in a healthcare case management and patient insurance/billing environment
- 3-4 years supervisory experience preferred
- Medical records coding experience is desirable
- Comprehensive knowledge of clinical documentation and medical coding
- Knowledge of patient financial billing regulations/requirements, reimbursement, managed care
Benefits:
- Health insurance
- Dental insurance
- Vision insurance
- Pharmacy benefits
- Discretionary annual bonuses
- Merit increases
- Flexible Spending Accounts
- 403(b) savings matches
- Paid time off
- Career advancement opportunities
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