RN Appeals Writer (Government Audit)

DescriptionRESPONSIBLE FOR:Detailed review, analysis and extraction of clinical information from patient medical records and drafting ofeffective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied casesunder appeal at all levels of the government appeals process; maintaining current knowledge base ofmedical coding, federal and state hospital Utilization Review (UR) regulations and Medicare guidelinesregarding medical necessity, inpatient, outpatient and observation; assisting Senior Director with researchand preparation for beneficiary hearings before the Administrative Law Judge (ALJ); potentially testifyingas expert witness in ALJ hearings; collaborating with internal and external legal resources in an effort tofacilitate the best possible outcomes in response to process or guideline changes that directly impact theRAC process.QualificationsMINIMUM EDUCATION REQUIRED:Graduate from an accredited School of NursingMinimum Experience RequiredClinical experience in healthcare setting with a minimum of 7 years using electronic medical records oracute hospital utilization review using InterQual or Milliman. Working knowledge of medical coding, casemanagement, government and contracted payers.Minimum Licensure/Certification Required By LawCurrent Georgia nursing licensure.Additional QualificationsExperience in clinical software such as SCM / Quest, STAR, EPIC, Client Tracking, and I-Suites. Previousexperience with medical record auditing with medical necessity claims; IQCI Certification preferredMicroSoft Word and Excel proficiency preferred. HealthPort systems experience a plus.#GD