RN Appeals Writer - Remote Piedmont Healthcare Inc. - 3.6 Atlanta, GA Job Details Full-time 7 hours ago Qualifications Nursing 7 years Medicare RN License Medical software Medical expert witness testimony Court testimony Medical coding guidelines Research Legal appeal drafting Expert witness consultation Case appeal in utilization management Medicare regulations InterQual Centers for Medicare and Medicaid Services (CMS) Health record chart audits Medical record abstraction Resource utilization in healthcare Medicaid regulations Medicaid Medical record review for legal cases Milliman Care Guidelines (MCG Health) Acute care experience Senior level Insurance claims appeal handling Healthcare coding investigations Administrative law Medical record review for billing accuracy Nurse Licensure Compact (NLC)

Full Job Description Overview:

Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current knowledge base of medical coding, federal and state hospital Utilization Review ("UR") regulations and Medicare guidelines regarding medical necessity, inpatient, outpatient and observation; assisting Senior Director with research and preparation for beneficiary hearings before the Administrative Law Judge ("ALJ"); potentially testifying as expert witness in ALJ hearings; collaborating with internal and external legal resources in an effort to facilitate the best possible outcomes in response to process or guideline changes that directly impact the RAC process.

Responsibilities:

Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current knowledge base of medical coding, federal and state hospital Utilization Review ("UR") regulations and Medicare guidelines regarding medical necessity, inpatient, outpatient and observation; assisting Senior Director with research and preparation for beneficiary hearings before the Administrative Law Judge ("ALJ"); potentially testifying as expert witness in ALJ hearings; collaborating with internal and external legal resources in an effort to facilitate the best possible outcomes in response to process or guideline changes that directly impact the RAC process.

Qualifications:

Education Graduate from an accredited School of Nursing Required Work Experience 7 years of clinical experience in a healthcare setting using electronic medical records or acute hospital utilization review using InterQual or Milliman Required Previous experience with medical record auditing with medical necessity claims Required Experience in clinical software such as SCM / Quest, STAR, EPIC, Client Tracking, and I-Suites is Preferred Licenses and Certifications Current License in the State of Georgia as a

Registered Nurse or NLC/eNLC Multistate License Required IQCI Certification Preferred Business Unit :

Company Name:

Piedmont Healthcare Corporate