Approval Officer responsible for reviewing and verifying pre‑authorization requests for medical services, ensuring compliance with insurance regulations, coding services accurately, and managing related reporting and communication with insurers and internal departments.
Responsibilities
Evaluate pre‑authorization requests for medical necessity
Accurately code service description codes using ICD, CPT, DRG, HCPCS
Respond to insurance/TPA queries and liaise with concerned departments
Receive, evaluate and escalate second opinion cases and case management requests
Prepare daily activity reports and assist with monthly reporting
Requirements
Bachelor's degree in Medicine or equivalent medical degree from a recognized university
Responsible for auditing, education, and training related to coding and documentation within UW Medicine’s Enterprise Records and Health Information department.
Compensation
Pay Range Minimum: $70,800.00 annual
Pay Range Maximum: $90,000.00 annual
Responsibilities
Perform coding audits and analyze results
Develop and deliver role‑specific training for ERHI coding staff
Maintain unit records and monitor regulatory developments
Coordinate with Compliance, Clinical Documentation Improvement, Utilization Management, and Patient Financial Services
Provide expert coding content knowledge to UW Medicine staff and stakeholders
Requirements
Bachelor’s degree in a Health Sciences discipline, Business Administration or related field
This position assists medical staff providers with documentation in the medical record, reviewing physician documentation daily to reflect the level of service provided and ensure accurate clinical severity capture.
Compensation
Minimum Offer $65,520.00 Maximum Offer $111,612.80
Responsibilities
Performs concurrent reviews of the medical record for inpatient admissions to include assignments of DRG
Identifying complication and co-morbid conditions and specific co-existing conditions
Works collaboratively with Medical Staff, Nursing Staff, and patient care givers to improve quality of chart documentation
Assist physicians with documentation requirements to support medical necessity for hospital and physician billing
Interprets clinical information in the medical record, ordered interventions, lab and test results, and queries if necessary
Requirements
Associates degree in Nursing
Bachelors degree
Nice to have: CCDS (Certified Clinical Documentation Specialist)
Case Manager and Utilization Review RN for Cancer Specialty Hospital. 5 years' experience required. Must have acute hospital experience. Epic & InterQual documentation; SBAR communication. Weekends required.
Certifications REQUIRED: BLS; BSN; State License
Skills/Experience REQUIRED: Acute Hospital; Long Term Acute Care/Rehab/Skilled Nursing; Admission Criteria; Care Coordination; Discharge Planning; Utilize InterQual Criteria; Utilize Milliman Guidelines; UR Admission Criteria; UR Appeals and Denials; UR Concurrent Review; UR Continued Stay Reviews; UR Medical Necessity; UR Retrospective Review; UR Utilize InterQual Criteria; UR Utilize Milliman Guidelines; CMS: Centers for Medicare and Medicaid Services; CPT (Current Procedural Terminology) coding and billing; Department of Health; DRG (Diagnosis Related Groups); HEDIS (The Healthcare Effectiveness Data and Information Set) Measures; HIPAA guidelines (Health Insurance Portability and Accountability Act); ICD 10 Coding; NCQA (National Committee for Quality Assurance); OSHA; The Joint Commission/ Core Measure/National Safety Goals
Workers Compensation
Case Manager and Utilization Review RN for Cancer Specialty Hospital. 5 years' experience required. Must have acute hospital experience. Epic & InterQual documentation; SBAR communication. Weekends required.
Certifications REQUIRED: BLS; BSN; State License
Skills/Experience REQUIRED: Acute Hospital; Long Term Acute Care/Rehab/Skilled Nursing; Admission Criteria; Care Coordination; Discharge Planning; Utilize InterQual Criteria; Utilize Milliman Guidelines; UR Admission Criteria; UR Appeals and Denials; UR Concurrent Review; UR Continued Stay Reviews; UR Medical Necessity; UR Retrospective Review; UR Utilize InterQual Criteria; UR Utilize Milliman Guidelines; CMS: Centers for Medicare and Medicaid Services; CPT (Current Procedural Terminology) coding and billing; Department of Health; DRG (Diagnosis Related Groups); HEDIS (The Healthcare Effectiveness Data and Information Set) Measures; HIPAA guidelines (Health Insurance Portability and Accountability Act); ICD 10 Coding; NCQA (National Committee for Quality Assurance); OSHA; The Joint Commission/ Core Measure/National Safety Goals
Workers Compensation
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