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
Piedmont Healthcare is a healthcare system that operates inpatient and outpatient service lines across multiple facilities within the Piedmont System. The organization manages comprehensive healthcare services with a focus on accurate medical coding, revenue cycle operations, and quality patient documentation. Piedmont Healthcare emphasizes employee wellness, professional development, and recognition, with leadership invested in staff success and career advancement.
