[Hiring] UM & Clinical Denials Assistant @Piedmont Healthcare Inc.

Role Description

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 information
• Lack of authorization
• Untimely notifications

This role will work closely with the physician to ensure that peer-to-peer reviews are completed in a timely manner. Additionally, this role will be responsible for:

• Investigating root causes of clinical denials
• Documenting findings in Epic
• Following up on appeal outcomes

Qualifications

• H.S. Diploma or General Education Degree (GED) Required
• Associate’s Degree in human services/healthcare related field, or coding Preferred
• 3 years of experience in either hospital billing, Care Management, utilization review or commercial/managed care Required
• None Required for Licenses and Certifications

Company Description

Business Unit: Company Name

Piedmont Healthcare Corporate