RN Appeals Writer

Overview:

​​​ Join Piedmont to move your career in the right direction. Stay for the diverse teams you’ll love, a shared purpose, and schedule flexibility that frees you to live for what matters both in and outside of work. You’ll feel valued, motivated to be your best, and recognized for your contributions to exceptional patient outcomes. Piedmont leaders are in your corner, invested in your success. Our wellness programs and comprehensive total benefits and rewards meet your needs today and help you plan for the future.

​​​ As an RN Appeals Writer , your dedication to holistic, patient-centered care in your community is deeply valued. Piedmont supports nurses with the compensation, work/life balance, and resources they deserve. You’ll work in a positive, collaborative environment alongside dedicated team members, and use state-of-the-art technology that strengthens patient care and services. You may participate in clinical research that opens doors to working on the forefront of medical advances and changes patient lives. Apply today to make a positive difference in every life you touch.

Total Rewards that work for you:

• Competitive and equitable compensation for all roles

• Total Wellness programs for you and your family

• Wellness Coaching App – 24/7 Live Coaching

• Physician and Nursing Peer Coaching

• Financial Wellness Planning and Education

• Broad Employee Assistance Program service

• PTO your way

• Combined PTO days for greater flexibility

• 100% paid Maternity Leave (requires return to work)

• Employer Paid Military Leave

• Opportunity for PTO cash-in

• Celebrate Diversity – Diversity, Inclusion and Equity Paid Holiday

• Benefits

• Choice of Medical/Prescription Drug Plans

• Dental and Vision

• Adoption Assistance

• Fertility, family building, menopause and midlife care for your family

• Flexible Spending Accounts (FSA) for Healthcare and Dependent Day Care

• Employer-paid Short Term and Long Term Disability

• Employer-paid Basic Life and Accidental Death & Dismemberment

• Tuition reimbursement for nursing programs

Responsibilities:

RESPONSIBLE FOR:
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:

MINIMUM EDUCATION REQUIRED:
Graduate from an accredited School of Nursing

MINIMUM EXPERIENCE REQUIRED:
Clinical experience in healthcare setting with a minimum of 7 years using electronic medical records or
acute hospital utilization review using InterQual or Milliman. Working knowledge of medical coding, case
management, government and contracted payers.

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
Current Georgia nursing licensure.

ADDITIONAL QUALIFICATIONS:
Experience in clinical software such as SCM / Quest, STAR, EPIC, Client Tracking, and I-Suites. Previous
experience with medical record auditing with medical necessity claims; IQCI Certification preferred
MicroSoft Word and Excel proficiency preferred. HealthPort systems experience a plus.

LI-POST

#GD

Business Unit : Name: Piedmont Healthcare