RN Appeals Writer

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.

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.

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