Piedmont HealthCare Verified
Healthcare, Medical Practice, Hospitals & Health Care
RN Appeals Writer – RAC for Home Health and Hospice
RemoteRemoteFull TimePosted 1 month agoVisa sponsorship availableHidden Gem · Himalayas
Required skills
- RN
- Registered Nurse
- Medicare
- Medicaid
- Appeals
- Home Health
- Hospice
- Clinical Experience
- Electronic Medical Records
- Utilization Review
Nice to have
- SCM / Quest
- STAR
- EPIC
- Client Tracking
- I-Suites
- Expert Witness
Role summary
The RN Appeals Writer will be responsible for reviewing and analyzing patient medical records to draft compelling narratives for Medicare and Medicaid appeals. This role requires a deep understanding of medical coding, utilization review regulations, and Medicare guidelines related to medical necessity. The position involves assisting with research for beneficiary hearings before the Administrative Law Judge (ALJ), potentially testifying as an expert witness, and collaborating with legal resources to achieve optimal outcomes in the RAC process. A minimum of 7 years of clinical experience and experience with electronic medical records or acute hospital utilization review are required.
Overview
Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current knowledge base of medical coding, federal and state hospital Utilization Review ("UR") regulations and Medicare guidelines regarding medical necessity, inpatient, outpatient and observation; assisting Senior Director with research and preparation for beneficiary hearings before the Administrative Law Judge ("ALJ"); potentially testifying as expert witness in ALJ hearings; collaborating with internal and external legal resources in an effort to facilitate the best possible outcomes in response to process or guideline changes that directly impact the RAC process.Responsibilities
Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government appeals process; maintaining current knowledge base of medical coding, federal and state hospital Utilization Review ("UR") regulations and Medicare guidelines regarding medical necessity, inpatient, outpatient and observation; assisting Senior Director with research and preparation for beneficiary hearings before the Administrative Law Judge ("ALJ"); potentially testifying as expert witness in ALJ hearings; collaborating with internal and external legal resources in an effort to facilitate the best possible outcomes in response to process or guideline changes that directly impact the RAC process.Qualifications
Education- Graduate from an accredited School of Nursing Required
- 7 years of clinical experience in a healthcare setting using electronic medical records or acute hospital utilization review using InterQual or Milliman Required
- Previous experience with medical record auditing with medical necessity claims Required
- Experience in clinical software such as SCM / Quest, STAR, EPIC, Client Tracking, and I-Suites is Preferred
- Current License in the State of Georgia as a Registered Nurse or NLC/eNLC Multistate License Required
- IQCI Certification Preferred
Business Unit : Company Name
Piedmont Healthcare CorporateOriginally posted on Himalayas
