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Job Description

UW Medicine’s 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 nation's 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

+ Bachelor’s 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 Washington’s only health system that includes a top-rated medical school and an internationally recognized research center. UW Medicine’s 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 tomorrow’s 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 29,000 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 (https://www.uwmedicine.org/jobs) . Join our mission to make life healthier for everyone in our community.

Compensation, Benefits and Position Details

Pay Range Minimum:

$102,000.00 annual

Pay Range Maximum:

$144,000.00 annual

Other Compensation:

-

Benefits:

For information about benefits for this position, visit https://www.washington.edu/jobs/benefits-for-uw-staff/

Shift:

First 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 world. In 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 (https://policy.uw.edu/directory/po/executive-orders/eo-81-prohibiting-discrimination-harassment-and-sexual-misconduct/) .

To request disability accommodation in the application process, contact the Disability Services Office at 206-543-6450 or [email protected] .

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 (https://app.leg.wa.gov/RCW/default.aspx?cite=28B.112.080) .

University of Washington is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.