RN Appeals Writer (Remote) Job at Piedmont Healthcare
RESPONSIBLE FOR:
Detailed review, analysis and extraction of clinical information from patient medical records and drafting of
effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases
under appeal at all levels of the government appeals process; maintaining current knowledge base of
medical coding, federal and state hospital Utilization Review (UR) regulations and Medicare guidelines
regarding medical necessity, inpatient, outpatient and observation; assisting Senior Director with research
and preparation for beneficiary hearings before the Administrative Law Judge (ALJ); potentially testifying
as expert witness in ALJ hearings; collaborating with internal and external legal resources in an effort to
facilitate the best possible outcomes in response to process or guideline changes that directly impact the
RAC process.
Requirements
MINIMUM EDUCATION REQUIRED:
Graduate from an accredited School of Nursing
MINIMUM EXPERIENCE REQUIRED:
Clinical experience in healthcare setting with a minimum of 7 years using electronic medical records or
acute hospital utilization review using InterQual or Milliman. Working knowledge of medical coding, case
management, government and contracted payers.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
Current Georgia nursing licensure.
ADDITIONAL QUALIFICATIONS:
Experience in clinical software such as SCM / Quest, STAR, EPIC, Client Tracking, and I-Suites. Previous
experience with medical record auditing with medical necessity claims; IQCI Certification preferred
MicroSoft Word and Excel proficiency preferred. HealthPort systems experience a plus.
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Diversity & Inclusion
At Piedmont Healthcare we embrace diverse ideas, perspectives, and skills to create a collaborative workplace where the best talent wants to succeed. We celebrate differences and recognize that they allow us to care for our community.
Excellence at Work
Piedmont is a certified Great Place to Work™- a national designation based on employee feedback about trust, workplace culture and experience. In 2019, Forbes named Piedmont one of Georgia’s 10 best employers and the highest-ranked healthcare provider.
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