Clinical Denials Prevention & Appeals Assistant

Piedmont Healthcare Inc.; United States; On-site; USD 48,000 - 60,000; Full time

Job summary

Piedmont Healthcare Corporate is seeking a detail-oriented professional to support the Utilization Management Nurse and the RN Appeals Writer within the Care Management Department. The role focuses on preventing clinical denials related to lack of clinical data, authorization, and untimely notifications.

You will collaborate with physicians to ensure timely peer-to-peer reviews, investigate root causes of denials, and document findings in Epic, following up on appeal outcomes.

Qualifications

• GED required.
• Associate's Degree in human services/healthcare related field, or coding preferred.
• 3 years of experience in either hospital billing, Care Management, utilization review or commercial / managed care.

Responsibilities

• Assist the Utilization Management Nurse and RN Appeals Writer in the Care Management Department; help prevent denials related to lack of clinical data, authorization, and untimely notifications.

Education

GED

Associate's Degree in human services/healthcare related field, or coding

Job description

Piedmont Healthcare Corporate is seeking a detail-oriented professional to support the Utilization Management Nurse and the RN Appeals Writer within the Care Management Department. The role focuses on preventing clinical denials related to lack of clinical data, authorization, and untimely notifications.

You will collaborate with physicians to ensure timely peer-to-peer reviews, investigate root causes of denials, and document findings in Epic, following up on appeal outcomes.