RN Appeals Writer - Remote

Piedmont Healthcare • Atlanta, GA

259d • Remote

About The Position

The RN Appeals Writer is responsible for the detailed review, analysis, and extraction of clinical information from patient medical records. This role involves drafting effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process. The RN Appeals Writer must maintain a current knowledge base of medical coding, federal and state hospital Utilization Review (UR) regulations, and Medicare guidelines regarding medical necessity, inpatient, outpatient, and observation. Additionally, the position includes assisting the Senior Director with research and preparation for beneficiary hearings before the Administrative Law Judge (ALJ) and potentially testifying as an expert witness in ALJ hearings. Collaboration with internal and external legal resources is also a key aspect of this role to facilitate the best possible outcomes in response to process or guideline changes that directly impact the RAC process.

Requirements

• Graduate from an accredited School of Nursing.
• Clinical experience in a healthcare setting with a minimum of 7 years using electronic medical records or acute hospital utilization review.
• Working knowledge of medical coding, case management, and government and contracted payers.
• Current Georgia nursing licensure.

Nice To Haves

• Experience in clinical software such as SCM / Quest, STAR, EPIC, Client Tracking, and I-Suites.
• Previous experience with medical record auditing with medical necessity claims.
• IQCI Certification preferred.
• MicroSoft Word and Excel proficiency preferred.
• HealthPort systems experience a plus.

Responsibilities

• Detailed review, analysis, and extraction of clinical information from patient medical records.
• Drafting effective narratives for Medicare and Medicaid appeals documentation and briefs.
• Maintaining current knowledge of medical coding, federal and state hospital Utilization Review regulations, and Medicare guidelines.
• Assisting Senior Director with research and preparation for beneficiary hearings before the Administrative Law Judge.
• Potentially testifying as an expert witness in ALJ hearings.
• Collaborating with internal and external legal resources to facilitate optimal outcomes.

What This Job Offers

• Job Type: Full-time
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree