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RN -Denial Reviewer - remote ID-10009

April 2, 2025

Job Description

PeaceHealth is seeking a RN Denial Reviewer for a Full Time, 1.00 FTE, Day position. The salary range for this job opening at PeaceHealth is $54.61 – $81.91. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.

Serves as subject matter content expert and change agent with in-depth knowledge of workflow related to denials and appeals management. Performs in depth reviews of clinical DRG downgrade denials to draft appeal letters for submission to payers. Provides support in development of the clinical denial process, letter templates, and process improvements.

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Ideal candidate will have experience with clinical DRG-downgrade denials in the inpatient acute care setting.

Details of the Position:

Ensures the overall accuracy, completeness and timeliness of the clinical documentation to support the clinical validity of denied diagnoses/DRG's
Performs in depth clinical reviews of denied records to author and submit initial as well as second level appeals to the payers.
Develops a deep understanding of denial payer pattern, serving as an educator/liaison to providers and caregivers to facilitate accuracy of clinical documentation, resulting in an understanding of documentation needs for denial mitigation.
May author, implement, and maintain written policies, procedures, and processes related to clinical denial/appeals. This includes formatted templated design for diagnosis specific appeals.
Acts as a resource for best practices in clinical documentation, impact of Medicare guidelines and facilitates educating key stakeholders.
Participates as a member of the CDI Task Force.
Applies knowledge of current Medicare part A and how it impacts DRG assignment to the review of clinical documentation.
Performs other duties as assigned.

What You Bring:

Education

Accredited School of Nursing Required: or
Doctor of Medicine Required: or
Master's Degree Preferred: Master of Science in Nursing or
Bachelor's Degree Preferred: Bachelor of Science in Nursing.

Experience

Minimum of 5 years Required: Experience as a Clinical Documentation Specialist in a hospital program and
Preferred: Experience with 3M 360 Encompass, CAC, and Epic software and
Preferred: Knowledge of pathophysiology and disease process and
Preferred: Knowledge of value-based purchasing and other quality metrics affecting the clinical documentation integrity program and
Preferred: Experience with clinical DRG-downgrade denials in the inpatient acute care setting

Credentials

Required: Registered Nurse In state of practice or
Required: Certified Clinical Documentation Specialist or
Required: Medical Doctor - Washington in state of practice

Skills

Strong verbal, written and interpersonal communication skills. (Required)
Ability to interact effectively with providers and all levels of staff to achieve quality outcomes. (Required)
Ability to effectively communicate clinical information. (Required)
Ability to analyze/problem solve. (Required)
Computer skills to include word processing, spreadsheet and data entry. (Required)
Strong organization skills with the ability to work in a fast-paced environment independently and as part of an interdisciplinary team. (Required)
Good critical thinking skills, able to assess, evaluate and teach. (Required)
Working knowledge of all areas of adult medicine. (Required)

Department / Location Specific Notes

Additional Registered Nurse licensure may be required within one year of hire, for work performed in other states where PeaceHealth does business.

Working Conditions

Lifting

Consistently operates computer and other office equipment.
Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
Sedentary work.

Environmental Conditions

Predominantly operates in an office environment.

Mental/Visual

Ability to communicate and exchange accurate information.
The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.

PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.

See how PeaceHealth is committed to

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

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With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

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6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

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The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

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This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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DISCLAIMER

RN -Denial Reviewer - remote ID-10009

Other Jobs You May Be Interested In

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

5. HOW DO YOU PROCESS INFORMATION?

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

8. HOW TO PRIORITIZE WORK?

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?