Clinical Denials & Appeals Support Specialist

Piedmont Healthcare; United States; Remote; USD 42,000 - 56,000; Full time

Job summary

Piedmont Healthcare Corporate seeks a detail‑oriented support professional for the Care Management Department. You will assist the Utilization Management Nurse and the RN Appeals Writer, helping prevent clinical denials due to lack of clinical data, authorization, or untimely notifications.

You will collaborate with physicians to ensure timely peer‑to‑peer reviews, document root‑cause analyses in Epic, and follow up on appeal outcomes to improve care management processes.

Qualifications

• H.S. Diploma or GED required.
• Associate's degree in healthcare-related field or coding preferred.
• 3 years of experience in hospital billing, care management, utilization review, or managed care required.
• Licenses/certifications: none required.

Responsibilities

• Support the Utilization Management Nurse and RN Appeals Writer in the Care Management Department.
• Help prevent clinical denials related to lack of clinical, lack of authorization, and untimely notifications.
• Work with physicians to ensure timely peer‑to‑peer reviews and document outcomes.
• Investigate root causes of clinical denials and document in Epic; follow up on appeal outcomes.

Education

High School Diploma / GED

Associate's degree in healthcare-related field or coding

Job description

Piedmont Healthcare Corporate seeks a detail‑oriented support professional for the Care Management Department. You will assist the Utilization Management Nurse and the RN Appeals Writer, helping prevent clinical denials due to lack of clinical data, authorization, or untimely notifications.

You will collaborate with physicians to ensure timely peer‑to‑peer reviews, document root‑cause analyses in Epic, and follow up on appeal outcomes to improve care management processes.