UM & Clinical Denials Asst
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AI Summary
This role supports the Utilization Management Nurse and RN Appeals Writer by investigating the root causes of clinical denials and documenting them in Epic. The assistant also coordinates with physicians to ensure timely peer-to-peer reviews and manages the follow-up of appeal outcomes.
Overview
Experience the advantages of real career change
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
- Associate’s Degree in human services/healthcare related field, or coding Preferred
- 3 years of experience in either hospital billing, Care Management, utilization review or commercial / managed care. Required
- None Required
Business Unit : Company Name
Piedmont Healthcare CorporateAutomatically Apply to the Best Remote Jobs
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