UM & Clinical Denials Asst-PRN

Piedmont Healthcare; United States; On-site; USD 42,000 - 56,000; Full time

Job summary

Piedmont Healthcare Corporate seeks a detail‑oriented support professional for the Care Management Department. You will assist the Utilization Management Nurse and the RN Appeals Writer, helping prevent clinical denials due to lack of clinical data, authorization, or untimely notifications.

You will collaborate with physicians to ensure timely peer‑to‑peer reviews, document root‑cause analyses in Epic, and follow up on appeal outcomes to improve care management processes.

Qualifications

• H.S. Diploma or GED required.
• Associate's degree in healthcare-related field or coding preferred.
• 3 years of experience in hospital billing, care management, utilization review, or managed care required.
• Licenses/certifications: none required.

Responsibilities

• Support the Utilization Management Nurse and RN Appeals Writer in the Care Management Department.
• Help prevent clinical denials related to lack of clinical, lack of authorization, and untimely notifications.
• Work with physicians to ensure timely peer‑to‑peer reviews and document outcomes.
• Investigate root causes of clinical denials and document in Epic; follow up on appeal outcomes.

Education

High School Diploma / GED

Associate's degree in healthcare-related field or coding

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

• 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