Job Description

Overview:

Experience the advantages of real career change

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Join Piedmont to move your career in the right direction. Stay for the diverse teams you'll love, a shared purpose, and schedule flexibility that frees you to live for what matters both in and outside of work. You'll feel valued, motivated to be your best, and recognized for your contributions to exceptional patient outcomes. Piedmont leaders are in your corner, invested in your success. Our wellness programs and comprehensive total benefits and rewards meet your needs today and help you plan for the future.




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 Associates 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. Demonstrable detailed levels of knowledge of commercial, government payer and/or denial rules are . Demonstrable detailed levels of knowledge of medical terminology Required

Licenses and Certifications

None Required
Business Unit : Name: Piedmont Healthcare