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Denials & Appeals RN Administrator
Boston Medical Center (BMC)RN Appeal Administrator responsible for validating patient care placements and managing denial processes. Collaborating with healthcare teams to reduce denial trends and secure clinical service authorizations.
Posted 6/16/2026full-timeRemote • Massachusetts • 🇺🇸 United StatesMid-LevelSenior💰 $43 - $63 per hourWebsite
About the role
Key responsibilities & impact- Responsible for the Pre-denial/ Denial and appeal process in addition to Utilization Review
- Validate the patient’s placement to the most appropriate level of care
- Use medical necessity screening tools to complete reviews
- Secure authorization for clinical services through timely collaboration with payers
- Follow the UR process, pre-denial and denial/appeal process
- Assess, plan, coordinate, and evaluate initial and ongoing denials
- Communicate with multiple members of the clinical team in clear concise language
- 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 as a registered nurse in the Commonwealth of Massachusetts
- Minimum 5 years of 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
- Working knowledge of patient financial billing regulations/requirements
Benefits
Comp & perks- medical 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
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Utilization Reviewmedical necessity screeningauthorization for clinical servicesmedical records codingclinical documentationmedical codingpatient financial billing regulations
Soft Skills
communicationcoordinationevaluationtrend identificationrecommendation
Certifications
Bachelor's Degree in NursingRegistered Nurse License