Clinical Appeals Specialist

2 weeks ago


Atlanta, Georgia, United States Piedmont Full time

JOB PURPOSE:


Conduct thorough evaluations, analyses, and extraction of clinical data from patient medical records, while composing effective narratives for Medicare and Medicaid appeals documentation and briefs concerning denied cases at all levels of the governmental appeals process. Maintain an up-to-date knowledge base of medical coding, federal and state hospital Utilization Review (UR) regulations, and Medicare guidelines related to medical necessity, inpatient, outpatient, and observation care. Assist the Senior Director with research and preparation for beneficiary hearings before the Administrative Law Judge (ALJ), and potentially serve as an expert witness during ALJ hearings. Collaborate with both internal and external legal resources to ensure optimal outcomes in response to procedural or guideline changes that directly affect the RAC process.


Qualifications

MINIMUM EDUCATION REQUIRED:
Graduate from an accredited School of Nursing.

Minimum Experience Required:
Seven (7) years of clinical experience in a healthcare environment utilizing electronic medical records or acute hospital utilization review employing InterQual or Milliman methodologies.

Minimum Licensure / Certification Required By Law:
Current License in the State of Georgia as a Registered Nurse or NLC/eNLC Multistate License.

Additional Qualifications:
Proficient understanding of medical coding, case management, and government and contracted payers. Experience with clinical software such as SCM / Quest, STAR, EPIC, Client Tracking, and I-Suites is preferred. Previous involvement in medical record auditing with medical necessity claims is advantageous. IQCI Certification is preferred. Proficiency in Microsoft Word and Excel is desirable. Familiarity with HealthPort systems is a plus.

#GD

  • Atlanta, Georgia, United States Piedmont Healthcare Corporate Full time

    About the Role:Piedmont Healthcare Corporate is seeking a skilled Clinical Appeals Specialist to join our team. As a Clinical Appeals Specialist, you will be responsible for reviewing and analyzing clinical information from patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key...


  • Atlanta, Georgia, United States Piedmont Healthcare Corporate Full time

    About the Role:Piedmont Healthcare Corporate is seeking a highly skilled Clinical Appeals Specialist to join our team. As a Clinical Appeals Specialist, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed...


  • Atlanta, Georgia, United States Piedmont Full time

    Job Summary:Piedmont is seeking a highly skilled Clinical Appeals Specialist to join our team. As a Clinical Appeals Specialist, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed reviews of patient medical...


  • Atlanta, Georgia, United States Piedmont Healthcare Corporate Full time

    Job Summary:Piedmont Healthcare Corporate is seeking a highly skilled Clinical Appeals Specialist to join our team. As a Clinical Appeals Specialist, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed reviews...


  • Atlanta, Georgia, United States Piedmont Healthcare Corporate Full time

    Job Summary:Piedmont Healthcare Corporate is seeking a highly skilled Clinical Appeals Specialist to join our team. As a Clinical Appeals Specialist, you will be responsible for reviewing and analyzing clinical information from patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key...


  • Atlanta, Georgia, United States Piedmont Healthcare Corporate Full time

    Job Summary:Piedmont Healthcare Corporate is seeking a highly skilled Clinical Appeals Specialist to join our team. As a Clinical Appeals Specialist, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed reviews...


  • Atlanta, Georgia, United States Piedmont Healthcare Corporate Full time

    Job SummaryPiedmont Healthcare Corporate is seeking a skilled Clinical Appeals Specialist to join our team. As a key member of our appeals process, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key ResponsibilitiesConduct detailed reviews of...


  • Atlanta, Georgia, United States Piedmont Healthcare Corporate Full time

    Job SummaryPiedmont Healthcare Corporate is seeking a skilled Clinical Appeals Specialist to join our team. As a key member of our appeals process, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key ResponsibilitiesConduct detailed reviews of...


  • Atlanta, Georgia, United States Piedmont Healthcare Corporate Full time

    About the Role:Piedmont Healthcare Corporate is seeking a highly skilled Clinical Appeals Specialist to join our team. As a key member of our appeals process, you will be responsible for reviewing and analyzing clinical information from patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key...


  • Atlanta, Georgia, United States Piedmont Full time

    JOB PURPOSE:The primary responsibility involves a comprehensive evaluation, analysis, and extraction of clinical data from patient medical records. This role focuses on crafting effective narratives for Medicare and Medicaid appeals documentation and briefs in support of cases that have been denied and are currently under appeal at various levels of the...


  • Atlanta, Georgia, United States Piedmont Full time

    JOB PURPOSE:The primary responsibility involves a comprehensive examination, evaluation, and extraction of clinical data from patient medical records. This role focuses on crafting precise narratives for Medicare and Medicaid appeals documentation and briefs concerning denied cases at all levels of the governmental appeals process. It is essential to...


  • Atlanta, Georgia, United States Piedmont HealthCare Full time

    PRIMARY RESPONSIBILITIES:Thorough examination, assessment, and extraction of clinical data from patient medical records, along with the composition ofpersuasive narratives for Medicare and Medicaid appeals documentation and briefs related to denied casesunder review at all levels of the governmental appeals framework; ensuring up-to-date knowledge ofmedical...


  • Atlanta, Georgia, United States Piedmont Full time

    JOB PURPOSE:The primary responsibility of this role involves a comprehensive examination, analysis, and extraction of clinical data from patient medical records. The aim is to craft compelling narratives for Medicare and Medicaid appeals documentation and briefs to support denied cases throughout all levels of the government appeals process. This position...


  • Atlanta, Georgia, United States Piedmont Full time

    JOB PURPOSE:The primary responsibility involves a comprehensive evaluation, analysis, and extraction of clinical data from patient medical records. This role requires drafting precise narratives for Medicare and Medicaid appeals documentation and briefs, supporting denied cases at all levels of the government appeals process. It is essential to maintain an...


  • Atlanta, Georgia, United States Piedmont HealthCare Full time

    PRIMARY RESPONSIBILITIES:Thorough examination, assessment, and extraction of clinical data from patient medical records, along with the composition ofeffective narratives for Medicare and Medicaid appeals documentation and briefs supporting denied casesunder review at all stages of the governmental appeals process. Keeping up-to-date withmedical coding,...


  • Atlanta, Georgia, United States Piedmont Full time

    JOB PURPOSE:The primary responsibility involves a thorough examination, assessment, and extraction of clinical data from patient medical records. This role includes the composition of compelling narratives for Medicare and Medicaid appeals documentation and briefs to support denied cases throughout all stages of the governmental appeals process. The position...

  • RN Appeals Writer

    2 months ago


    Atlanta, Georgia, United States Piedmont Healthcare Full time

    RESPONSIBLE FOR:Detailed review, analysis and extraction of clinical information from patient medical records and drafting ofeffective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied casesunder appeal at all levels of the government appeals process; maintaining current knowledge base ofmedical coding, federal and...

  • RN Appeals Writer

    2 months ago


    Atlanta, Georgia, United States Piedmont Full time

    JOB PURPOSE: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...

  • Staff Attorney

    7 days ago


    Atlanta, Georgia, United States Eleventh Circuit Court of Appeals Full time

    About the Position:The Eleventh Circuit Court of Appeals is seeking a highly skilled Staff Attorney to support the court's operations. As a key member of the court's staff, the successful candidate will be responsible for reviewing case records and filings, conducting legal research, and drafting bench memoranda and proposed opinions to assist the judges in...


  • Atlanta, Georgia, United States US Tech Solutions Full time

    Job Title: Clinical Services Authorization Specialist Location: Fully remote Duration: 10 months contract Job Overview: The Clinical Services Authorization Specialist will play a vital role in supporting various operational tasks, including but not limited to: making outbound calls, reviewing and processing authorization requests received through...