Clinical Appeals and Disputes Nurse

Seattle, OR - USA

Monthly Salary: Not Disclosed

Posted on: 2 days ago

Vacancies: 1 Vacancy

Job Summary

Job Description

UW Medicines Patient Financial Services Department has an outstanding opportunity for a Clinical Appeals and Disputes Nurse.

WORK SCHEDULE

100% FTE
100% Remote
Days

POSITION HIGHLIGHTS

The Clinical Appeals and Disputes Nurse ensures that payers are prepared to reimburse the UW Medicine for services in accordance with the payer-provider contract and works diligently toward the identification mitigation and prevention of clinical denials. This staff member uses their clinical expertise while reviewing initial clinical denials to determine next steps. Additionally they conduct appeals as appropriate by reviewing medical necessity and/or reconciling coverage-related issues.

DEPARTMENT DESCRIPTION

UW Medicine Patient Financial Services is a shared services department. UW Medicine includes UW Medical Center (UWMC) one of the nations premier educational and research institutions and Harborview Medical Center (HMC) the only Level I trauma center in the entire WWAMI/five-state region. Patient Financial Services is responsible for the patient accounting functions for UWMC and HMC including billing for inpatient and outpatient services provided at the Medical Centers.

PRIMARY JOB RESPONSIBILITIES

Document all payer communications thoroughly and communicated payer decisions in a timely manner
Review clinical denials and initiate appeals process
Conduct medical necessity reviews based on denial root cause and prepares any required clinical documentation summaries to accompany appeals
Help present appeals arguments to Administrative Law Judge
Monitor and follow up on appeals throughout entire process determine next steps to ensure appeals either result in an overturned denial or have proceeded
as far as possible
Identify gaps in clinical documentation and work with clinical staff to develop and implement quality improvement and staff education initiatives
Assess the quality of charge capture and coding as they relate to clinical denials; assist revenue cycle leadership in improving processes
Analyze initial and fatal denial data to identify trends; share findings with revenue cycle leadership to drive process improvements
Review payer updates and communicate changes impacting revenue cycle

REQUIREMENTS

Active licensure to practice as a Registered Nurse in Washington State
Bachelors degree in Nursing
Certification in at least one of the following: certified healthcare chart auditor certified professional in utilization review (or utilization management or healthcare management) certified case manager certified documentation specialist certified coder certified professional medical auditor
Previous experience working as an RN
Extensive knowledge of ICD-10-PCS ICD-10-CM CPT and HCPCS coding principles and guidelines
Comprehensive knowledge of federal and state regulations related to documentation coding and billing
At least three years of experience required in one of the following areas: clinical case management denials billing
Familiarity with National Coverage Determinations and Local Coverage Determinations
Proficient in medical terminology and able to interpret patient medical records
Knowledge of medical necessity screening criteria (e.g. Milliman InterQual)

ABOUT UW MEDICINE - WHERE YOUR IMPACT GOES FURTHER

UW Medicine is Washingtons only health system that includes a top-rated medical school and an internationally recognized research center. UW Medicines mission is to improve the health of the public by advancing medical knowledge providing outstanding primary and specialty care to the people of the region and preparing tomorrows physicians scientists and other health professionals.

All across UW Medicine our employees collaborate to perform the highest quality work with integrity and compassion and to create a respectful welcoming environment where every patient family student and colleague is valued and honored. Nearly 29000 healthcare professionals researchers and educators work in the UW Medicine family of organizations that includes: Harborview Medical Center UW Medical Center - Montlake UW Medical Center - Northwest Valley Medical Center UW Medicine Primary Care UW Physicians UW School of Medicine and Airlift Northwest.

Become part of our team. Join our mission to make life healthier for everyone in our community.

Compensation Benefits and Position Details

Pay Range Minimum:

$102000.00 annual

Pay Range Maximum:

$144000.00 annual

Other Compensation:

Benefits:

For information about benefits for this position visit Shift (United States of America)

Temporary or Regular

This is a regular position

FTE (Full-Time Equivalent):

100.00%

Union/Bargaining Unit:

Not Applicable

About the UW

Working at the University of Washington provides a unique opportunity to change lives on our campuses in our state and around the world.

UW employees bring their boundless energy creative problem-solving skills and dedication to building stronger minds and a healthier return they enjoy outstanding benefits opportunities for professional growth and the chance to work in an environment known for its diversity intellectual excitement artistic pursuits and natural beauty.

Our Commitment

The University of Washington is committed to fostering an inclusive respectful and welcoming community for all. As an equal opportunity employer the University considers applicants for employment without regard to race color creed religion national origin citizenship sex pregnancy age marital status sexual orientation gender identity or expression genetic information disability or veteran status consistent with UW Executive Order No. 81.

To request disability accommodation in the application process contact the Disability Services Office at or .

Applicants considered for this position will be required to disclose if they are the subject of any substantiated findings or current investigations related to sexual misconduct at their current employment and past employment. Disclosure is required under Washington state law.

Required Experience:

Job DescriptionUW Medicines Patient Financial Services Department has an outstanding opportunity for a Clinical Appeals and Disputes Nurse.WORK SCHEDULE100% FTE100% RemoteDaysPOSITION HIGHLIGHTSThe Clinical Appeals and Disputes Nurse ensures that payers are prepared to reimburse the UW Medicine for ...