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RN Appeals Writer
2 months ago
JOB PURPOSE:
Detailed review,analysis and extraction of clinical information from patientmedical records and drafting of effective narratives for Medicareand Medicaid appeals documentation and briefs in support of deniedcases under appeal at all levels of the government appeals process;maintaining current knowledge base of medical coding, federal andstate hospital Utilization Review (UR) regulations and Medicareguidelines regarding medical necessity, inpatient, outpatient andobservation; assisting Senior Director with research andpreparation for beneficiary hearings before the Administrative LawJudge (ALJ); potentially testifying as expert witness in ALJhearings; collaborating with internal and external legal resourcesin an effort to facilitate the best possible outcomes in responseto process or guideline changes that directly impact the RACprocess.
Qualifications:
MINIMUMEDUCATION REQUIRED:
Graduate from anaccredited School ofNursing.
MINIMUM EXPERIENCEREQUIRED:
Seven (7) years of clinicalexperience in a healthcare setting using electronic medical recordsor acute hospital utilization review using InterQual orMilliman.
MINIMUM LICENSURE /CERTIFICATION REQUIRED BY LAW:
CurrentLicense in the State of Georgia as a Registered Nurse or NLC/eNLCMultistate License.
ADDITIONALQUALIFICATIONS:
Working knowledge ofmedical coding, case management, government and contractedpayers.
Experience in clinical software such as SCM /Quest, STAR, EPIC, Client Tracking, and I-Suites is desired.Previous experience with medical record auditing with medicalnecessity claims.
IQCI Certificationpreferred.
MicroSoft Word and Excel proficiencypreferred.
HealthPort systems experience aplus.
#GD #LI-POST
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