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Clinical Appeals Analyst (Remote)

Company: Piedmont Healthcare
Location: Atlanta
Posted on: November 26, 2022

Job Description:

RESPONSIBLE FOR:



Handling denials/appeals received from third party payers, managed care companies and/or government entities/auditors



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.

Keywords: Piedmont Healthcare, Atlanta , Clinical Appeals Analyst (Remote), Healthcare , Atlanta, Georgia

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