UM & Clinical Denials Asst-PRN

Piedmont-Healthcare; Atlanta (GA); On-site; USD 50,000 - 70,000; Full time

Job summary

Piedmont Healthcare Corporate is seeking a Care Management support professional to assist the Utilization Management Nurse and RN Appeals Writer. 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 denial root causes, and document outcomes in Epic, with diligent follow-up on appeals.

Qualifications

• H.S. Diploma or GED is 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 commercial / managed care is required.
• None certificates or licenses are required.

Responsibilities

• Support the Utilization Management Nurse and RN Appeals Writer in the Care Management Department to prevent clinical denials.
• Assist in ensuring peer-to-peer reviews are completed in a timely manner with physicians.
• Investigate root causes of clinical denials and document findings in Epic, with follow-up of appeal outcomes.

Education

H.S. Diploma or GED

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

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