Julia Duke - Claims/Reconsiderations/Reimbursement Review Nurse - Providence Health Plan | Himalayas
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Julia Duke

@juliaduke

Dedicated nursing professional with over 20 years of experience.

United States
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What I'm looking for

I seek a role that values collaboration and continuous learning in nursing.

I am a highly motivated and dedicated nursing professional with over twenty years of experience in various nursing roles. My journey in the nursing field has been marked by continuous learning and a commitment to providing exceptional patient care. I thrive in collaborative environments and enjoy working closely with my colleagues to ensure the best outcomes for our patients.

Currently, I serve as a Claims/Reconsiderations/Reimbursement Review Nurse at Providence Health Plan, where I conduct post-service reviews on denied claims and analyze hospital cases for preventable adverse events. My previous roles have included concurrent review nursing and telephonic triage, where I utilized my clinical expertise to support patients and healthcare teams effectively. I am passionate about improving healthcare processes and outcomes through diligent review and assessment.

Experience

Work history, roles, and key accomplishments

PP
Current

Claims/Reconsiderations/Reimbursement Review Nurse

Providence Health Plan

Apr 2024 - Present (1 year 3 months)

Provided post-service reviews on denied claims and conducted reviews on hospital deaths and Medicare claims for preventable adverse events. Utilized various reference resources including Interqual, Medical Policy, and MCG guidelines.

PP

Concurrent Review Nurse

Providence Health Plan

Mar 2015 - Present (10 years 4 months)

Provided concurrent review nursing using Interqual criteria for inpatient Providence Health Plan members. Assisted inpatient case managers with discharge planning.

PT

Registered Nurse

Providence Telephone Triage

Sep 2014 - Present (10 years 10 months)

Provided telephonic triage nursing advice to patients ranging from newborn to geriatric. Charting was done on computers using Epic and E Centaurus programs.

SR

Registered Nurse

Sacred Heart Medical Center Riverbend

Apr 2009 - Present (16 years 3 months)

Provided nursing care to neurology patients within the hospital setting. All charting was done on computers with medication scanning technology.

PC

Registered Nurse

Providence St Vincent Medical Center

Oct 2005 - Present (19 years 9 months)

Provided nursing care to general surgical and orthopedic patients within the hospital setting. All charting was done on computers with medication scanning technology.

PC

Registered Nurse

Providence Center for Medically Fragile Children

Aug 2004 - Present (20 years 11 months)

Provided nursing care to developmentally and physically disabled pediatric patients in a long-term residential care facility. Charting was done both on paper and computer.

HC

Registered Nurse

Hillsboro Rehab and Specialty Care

Jun 2003 - Present (22 years 1 month)

Provided nursing care to patients in skilled, long-term care, and memory care settings with an average patient load of 15-23. All charting was done on paper.

Education

Degrees, certifications, and relevant coursework

BU

Brigham Young University

Associate's Degree in Nursing, Nursing

Grade: 3.2

Obtained an Associate's Degree in Nursing, focusing on foundational nursing principles and patient care. Achieved a GPA of 3.2.

SO

South University Online

Bachelor's Degree in Nursing, Nursing

Grade: 3.82

Completed a Bachelor's Degree in Nursing through an online program, expanding knowledge in advanced nursing practices and healthcare systems. Maintained a strong academic record with a GPA of 3.82.

Tech stack

Software and tools used professionally

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