Denials & Appeals Administrator, RN

Boston Medical Center (BMC)

RN Appeal Administrator overseeing pre-denial and appeal processes in healthcare settings. Collaborating with clinical teams to manage denials and ensure appropriate patient care steps.

Posted 6/16/2026full-timeRemote • Massachusetts • 🇺🇸 United StatesMid-LevelSenior💰 $4,303 - $6,250 per hourWebsite

About the role

Key responsibilities & impact

Responsible for the Pre-denial/ Denial and appeal process
Validate placement of patients based on admission criteria
Use medical necessity screening tools for reviews
Secure authorization for patient services through collaboration with payers
Assess, plan, coordinate, and evaluate initial and ongoing denials
Research and respond to denials in a timely fashion
Communicate with clinical team members to resolve denials
Identify trends and recommend changes to reduce denials

Requirements

What you’ll need

Requires Bachelor's Degree in Nursing or related field
Licensed to practice professional nursing in Massachusetts
Minimum 5 years related experience in 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
Working knowledge of patient financial billing regulations/requirements, reimbursement, managed care
Advanced interpersonal skills necessary to work with physicians, hospital directors, and managers

Benefits

Comp & perks

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
Resources to support employee and family well-being

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical necessity screeningpatient services authorizationmedical records codingclinical documentationmedical codingpatient financial billing regulationsreimbursementmanaged care

Soft Skills

interpersonal skillscommunicationcollaborationcoordinationevaluationresearchproblem-solving

Certifications

Bachelor's Degree in NursingLicensed to practice professional nursing in Massachusetts