RN Appeals Writer: Medicare & Medicaid Narratives

Piedmont; Atlanta (GA); On-site; USD 90,000 - 120,000; Full time

Job summary

Piedmont Healthcare Corporate is seeking an experienced Nurse Auditor to perform detailed reviews and extraction of clinical information from patient records for Medicare/Medicaid appeals. The role supports ALJ hearings and collaborates with internal and external legal resources to ensure compliant, effective narratives and documentation.

Required is a Nursing degree (RN) with Georgia licensure, plus extensive experience in electronic medical records and utilization review, and familiarity with

Qualifications

• Graduate from an accredited School of Nursing Required.
• 7 years of clinical experience in a healthcare setting using electronic medical records or acute hospital utilization review using InterQual or Milliman Required.
• Experience in clinical software such as SCM / Quest, STAR, EPIC, Client Tracking, and I-Suites is Preferred.

Responsibilities

• Detailed review, analysis and extraction of clinical information from patient medical records and drafting of narratives for Medicare/Medicaid appeals.
• Support for beneficiary hearings before the Administrative Law Judge (ALJ) and collaboration with legal resources to improve RAC process outcomes.

Skills

Nursing

Medical record auditing

EMR proficiency

Education

Nursing degree (RN)

Tools

SCM / Quest

STAR

EPIC

Client Tracking

I-Suites

Job description

Piedmont Healthcare Corporate is seeking an experienced Nurse Auditor to perform detailed reviews and extraction of clinical information from patient records for Medicare/Medicaid appeals. The role supports ALJ hearings and collaborates with internal and external legal resources to ensure compliant, effective narratives and documentation.

Required is a Nursing degree (RN) with Georgia licensure, plus extensive experience in electronic medical records and utilization review, and familiarity with