UM & Clinical Denials Asst-PRN

Piedmont Healthcare Inc.; Atlanta (GA); On-site; USD 55,000 - 75,000; Full time

Job summary

Piedmont Healthcare Corporate is seeking a Care Management Support role to assist the Utilization Management Nurse and RN Appeals Writer in the Care Management Department. The position aims to prevent clinical denials by ensuring proper data and timely notifications, while collaborating with physicians on peer-to-peer reviews.

Responsibilities include investigating denial root causes, documenting in Epic, and supporting follow-up of appeal outcomes.

Qualifications

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

Responsibilities

• Support the Utilization Management Nurse and RN Appeals Writer in the Care Management Department to prevent clinical denials.
• Work with physicians to ensure timely peer-to-peer reviews and investigate root causes of denials.
• Document findings in Epic and follow up on appeal outcomes.

Education

GED

Associate’s Degree

Job description

Overview

The purpose of this role is to provide support to the Utilization Management Nurse and RN Appeals Writer in the Care Management Department. This role will help to prevent clinical denials related to lack of clinical, lack of authorization and untimely notifications. This role will work closely with the physician to ensure that peer-to-peer reviews are completed in a timely manner. This role will be responsible for investigating root cause of clinical denials and documenting them in Epic and follow-up of appeal outcome.

Responsibilities

The purpose of this role is to provide support to the Utilization Management Nurse and RN Appeals Writer in the Care Management Department. This role will help to prevent clinical denials related to lack of clinical, lack of authorization and untimely notifications. This role will work closely with the physician to ensure that peer-to-peer reviews are completed in a timely manner. This role will be responsible for investigating root cause of clinical denials and documenting them in Epic and follow-up of appeal outcome.

Qualifications

Education

• H.S. Diploma or General Education Degree (GED) Required
• Associate’s Degree in human services/healthcare related field, or coding Preferred

Work Experience

• 3 years of experience in either hospital billing, Care Management, utilization review or commercial / managed care. Required

Licenses and Certifications

• None Required

Business Unit : Company Name

Piedmont Healthcare Corporate