Clinical Appeals Analyst (Remote) Job at Piedmont Healthcare
RESPONSIBLE FOR:
Handling denials/appeals received from third party payers, managed care companies and/or government entities/auditors
Requirements
MINIMUM EDUCATION REQUIRED:
Associate Degree in Nursing.
MINIMUM EXPERIENCE REQUIRED:
Five years acute care experience preferably in medical-surgical or critical care and two years recent experience in dispute management, clinical documentation, utilization review and/or case management.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
Current, valid RN licensure.
ADDITIONAL QUALIFICATIONS:
Certification in clinical specialty area or other area such as Case Management, Auditing, Legal Nurse Consulting or other related certification preferred. Government and/or managed care payor experience a plus either in Utilization Review, Case Management or Appeals preferred. Patient accounting experience a plus. Prior litigation experience (hearings, expert witness, depositions, etc.) a plus. Previous classroom led instruction on InterQual products preferred. Previous experience with Epic preferred.
Diversity & Inclusion
At Piedmont Healthcare we embrace diverse ideas, perspectives, and skills to create a collaborative workplace where the best talent wants to succeed. We celebrate differences and recognize that they allow us to care for our community.
Excellence at Work
Piedmont is a certified Great Place to Work™- a national designation based on employee feedback about trust, workplace culture and experience. In 2019, Forbes named Piedmont one of Georgia’s 10 best employers and the highest-ranked healthcare provider.
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