Piedmont Healthcare
Overview
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 Responsibly for detailed review, analysis and extraction of clinical information from patient medical records and drafting 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
Graduate from an accredited School of Nursing
Clinical experience in a healthcare setting with a minimum of 7 years using electronic medical records or acute hospital utilization review using InterQual or Milliman. Working knowledge of medical coding, case management, government and contracted payers.
Current Georgia nursing licensure.
Experience in clinical software such as SCM / Quest, STAR, EPIC, Client Tracking, and I-Suites. Previous experience with medical record auditing with medical necessity claims; IQCI Certification preferred. MicroSoft Word and Excel proficiency preferred. HealthPort systems experience a plus.
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Responsibilities Responsibly for detailed review, analysis and extraction of clinical information from patient medical records and drafting 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
Graduate from an accredited School of Nursing
Clinical experience in a healthcare setting with a minimum of 7 years using electronic medical records or acute hospital utilization review using InterQual or Milliman. Working knowledge of medical coding, case management, government and contracted payers.
Current Georgia nursing licensure.
Experience in clinical software such as SCM / Quest, STAR, EPIC, Client Tracking, and I-Suites. Previous experience with medical record auditing with medical necessity claims; IQCI Certification preferred. MicroSoft Word and Excel proficiency preferred. HealthPort systems experience a plus.
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