RN Appeals Writer: Medicare/Medicaid Narrative Expert

Piedmont; Atlanta (GA); On-site; USD 95,000 - 130,000; Full time

Job summary

Piedmont Healthcare Corporate in Georgia seeks a skilled nurse reviewer to extract and synthesize clinical information from patient records for Medicare and Medicaid appeals, drafting clear narratives for deny/different levels of government review.

You will maintain up-to-date knowledge of UR regulations, medical necessity guidelines, and work with senior leadership to prepare for beneficiary hearings, potentially testifying as an expert witness.

Qualifications

• Graduate from an accredited School of Nursing Required.
• 7 years of clinical experience in healthcare with EMR or hospital utilization review required.
• Experience with medical record auditing and medical necessity claims required.
• Experience with InterQual or Milliman utilization review preferred.
• Georgia RN license required or NLC/eNLC multistate license.

Responsibilities

• Detailed review, analysis and extraction of clinical information from patient medical records for Medicare/Medicaid appeals.
• Drafting narratives in support of denied cases under appeal at all levels of government.
• Maintain knowledge base of UR regulations and Medicare guidelines regarding medical necessity, inpatient, outpatient and observation.
• Assist senior director with research and preparation for beneficiary hearings before the ALJ; potentially testify as expert witness.

Skills

Clinical experience

EMR systems

Medical record auditing

InterQual/Milliman

Education

RN degree

Tools

SCM/Quest

STAR

EPIC

Client Tracking

I-Suites

Job description

Piedmont Healthcare Corporate in Georgia seeks a skilled nurse reviewer to extract and synthesize clinical information from patient records for Medicare and Medicaid appeals, drafting clear narratives for deny/different levels of government review.

You will maintain up-to-date knowledge of UR regulations, medical necessity guidelines, and work with senior leadership to prepare for beneficiary hearings, potentially testifying as an expert witness.