RN Appeals Writer: Medicare/Medicaid Narratives

Piedmont Healthcare Inc.; Atlanta (GA); On-site; USD 90,000 - 115,000; Full time

Job summary

Piedmont Healthcare Corporate seeks a nurse reviewer to perform detailed extraction of clinical information from patient records for Medicare/Medicaid appeals, while maintaining current knowledge of UR regulations and Medicare guidelines. The role supports senior leadership and may involve expert testimony in ALJ hearings.

You will review medical records, draft narratives for appeals, and collaborate with legal resources to respond to policy changes affecting RAC processes.

Qualifications

• Graduate from an accredited School of Nursing.
• 7 years of clinical healthcare experience with EMR or utilization review using InterQual or Milliman.
• Experience in medical record auditing for medical necessity.

Responsibilities

• Analyze clinical information from patient records for Medicare/Medicaid appeals.
• Draft narratives for appeals at all government appeal levels.
• Maintain knowledge base of UR regulations and Medicare guidelines.
• Assist in ALJ hearing preparation; potentially testify as expert witness.
• Collaborate with internal and external legal resources to adapt to RAC changes.

Education

Graduate from an accredited School of Nursing

Tools

InterQual or Milliman

Epic

SCM / Quest

STAR

Client Tracking

I-Suites

Job description

Piedmont Healthcare Corporate seeks a nurse reviewer to perform detailed extraction of clinical information from patient records for Medicare/Medicaid appeals, while maintaining current knowledge of UR regulations and Medicare guidelines. The role supports senior leadership and may involve expert testimony in ALJ hearings.

You will review medical records, draft narratives for appeals, and collaborate with legal resources to respond to policy changes affecting RAC processes.