UM & Clinical Denials Asst-PRN

Piedmont Healthcare Inc. • Vinings, GA

1d

About The Position

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.

Requirements

• H.S. Diploma or General Education Degree (GED) Required
• 3 years of experience in either hospital billing, Care Management, utilization review or commercial / managed care. Required

Nice To Haves

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

Responsibilities

• Provide support to the Utilization Management Nurse and RN Appeals Writer in the Care Management Department.
• Help to prevent clinical denials related to lack of clinical, lack of authorization and untimely notifications.
• Work closely with the physician to ensure that peer-to-peer reviews are completed in a timely manner.
• Investigate root cause of clinical denials and document them in Epic.
• Follow-up of appeal outcome.

What This Job Offers

• Career Level: Mid Level
• Education Level: High school or GED