Clinical Appeals Analyst (Remote)
Company: Piedmont Healthcare
Posted on: November 26, 2022
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
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
Current, valid RN licensure.
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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