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Piedmont · 1 month ago

RN Appeals Writer

United States

Full-time

Remote

Senior Level

7+ years exp

Piedmont Healthcare Corporate is seeking an RN Appeals Writer to join their team. The role involves detailed review and analysis of clinical information to draft effective narratives for Medicare and Medicaid appeals documentation, as well as maintaining knowledge of medical coding and regulations.

Hospital & Health Care

Responsibilities

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

Qualification

Clinical experienceMedical codingUtilization Review knowledgeInterQual experienceMilliman experienceSCM / Quest softwareEPIC softwareMicrosoft WordMicrosoft ExcelGeorgia nursing licensureExpert witness experienceHealthPort systems experienceMedical record auditing

Required

Graduate from an accredited School of Nursing

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

Current Georgia nursing licensure