UM & Clinical Denials Asst

About the role

Provide support to the Utilization Management Nurse and RN Appeals Writer in the Care Management Department. Help prevent clinical denials related to lack of clinical documentation, lack of authorization, and untimely notifications. Work closely with physicians to ensure timely completion of peer-to-peer reviews. Investigate root causes of clinical denials, document findings in Epic, and follow up on appeal outcomes.

Responsibilities

• Support Utilization Management Nurse and RN Appeals Writer in Care Management
• Prevent clinical denials due to lack of clinical documentation, authorization, or untimely notifications
• Collaborate with physicians to complete peer-to-peer reviews in a timely manner
• Investigate root causes of clinical denials and document them in Epic
• Follow up on appeal outcomes

Requirements

• High School Diploma or General Education Degree (GED) Required
• Associates Degree in human services, healthcare-related field, or coding Preferred
• 3 years of experience in hospital billing, Care Management, utilization review, or commercial/managed care Required

Business Unit: Piedmont Healthcare Corporate