UM & Clinical Denials Asst-PRN

Overview

The purpose of this role is to provide support to the Utilization Management Nurse and RN Appeals Writer in the Care Management Department. This role will help to prevent clinical denials related to lack of clinical, lack of authorization and untimely notifications. This role will work closely with the physician to ensure that peer-to-peer reviews are completed in a timely manner. This role will be responsible for investigating root cause of clinical denials and documenting them in Epic and follow-up of appeal outcome.

Responsibilities

The purpose of this role is to provide support to the Utilization Management Nurse and RN Appeals Writer in the Care Management Department. This role will help to prevent clinical denials related to lack of clinical, lack of authorization and untimely notifications. This role will work closely with the physician to ensure that peer-to-peer reviews are completed in a timely manner. This role will be responsible for investigating root cause of clinical denials and documenting them in Epic and follow-up of appeal outcome.

Qualifications

Education

H.S. Diploma or General Education Degree (GED) Required

Associate’s Degree in human services/healthcare related field, or coding Preferred

Work Experience

3 years of experience in either hospital billing, Care Management, utilization review or commercial / managed care. Required

Licenses and Certifications

None Required

Business Unit : Company Name

Piedmont Healthcare Corporate

Originally posted on Himalayas