About the Opportunity
Our client is looking for a dedicated Denials and Appeals Manager with an RN license to join their team in the Bronx, NY. The role will be responsible for overseeing the denials and appeals process to ensure timely and accurate resolution of claim denials and disputes. This RN manager will work closely with the billing department, healthcare providers, and insurance companies to identify and address denials, file appeals, and advocate for the reimbursement of denied claims. The ideal candidate will have a background in nursing, experience in insurance, and expertise in utilization review.
The annual base salary range is $100,00 to $110,000. Actual compensation offered to the successful candidate may vary from posted hiring range based upon geographic location, work experience, education, and/or skill level, among other things. Details about eligibility for bonus compensation (if applicable) will be finalized at the time of offer.
Job Responsibilities
- Manage the denials and appeals process for all denied claims, including reviewing denial reasons, gathering necessary documentation, and preparing appeals
- Analyze denial trends and identify opportunities for process improvement to prevent future denials
- Collaborate with healthcare providers, including physicians, nurses, and other clinical staff, to gather supporting documentation for appeals
- Communicate with insurance companies and third-party payers to negotiate claim resolutions and ensure timely payment
- Monitor the status of appeals and provide regular updates to stakeholders on progress and outcomes
- Serve as a subject matter expert on insurance regulations, coverage policies, and reimbursement guidelines
- Develop and implement training programs for staff on denials management best practices and appeal strategies
- Maintain accurate records of denials, appeals, and outcomes for reporting and auditing purposes
Job Requirements
- Active Registered Nurse (RN) license in the state of New York
- Bachelor’s degree in Nursing or related field preferred
- Minimum of 2 years of experience working in healthcare, with a focus on denials management, appeals, or utilization review
- Strong understanding of insurance billing, reimbursement, and claims processing
- Excellent analytical and problem-solving skills, with the ability to identify root causes of denials and implement effective solutions
