Clinical Appeals Analyst (Remote)
Description: RESPONSIBLE FOR: Handling denials/appeals received from third party payers, managed care companies and/or government entities/auditors Qualifications... 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 management. MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW: Current, valid RN licensure. ADDITIONAL QUALIFICATIONS: 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. DIVERSITY & INCLUSION At Piedmont Healthcare we embrace diverse ideas, perspectives, and skills to create a collaborative workplace where the best talent wants to succeed. We celebrate differences and recognize that they allow us to care for our community. EXCELLENCE AT WORK Piedmont is a certified Great Place to Work?? a national designation based on employee feedback about trust, workplace culture and experience. In 2019, Forbes named Piedmont one of Georgia?s 10 best employers and the highest-ranked healthcare provider. Position Information LOCATION Atlanta, Georgia POSTED 11/13/2023 TYPE Other JOB ID 1079479
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