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