Revenue Cycle Precertification Nurse- LPN- PRN- Remote

About the role

We ensure the financial security of scheduled inpatient and outpatient accounts for the company's patients by obtaining/initiating prior authorization of ordered services based on payer requirements, after benefits and eligibility have been determined. We coordinate with physicians and staff for appropriate level of care settings and essential clinical documentation to support medical necessity of services ordered. We work collaboratively with Case Management to establish level of care for direct admits and inpatient stays. Additionally, we act as a resource for the Revenue Cycle staff within Pre-Service.

Responsibilities

• Secures clinical documentation and performs pre-service medical necessity reviews to obtain prior authorizations.
• Maintains professional and technical knowledge and certifications.
• Ensures all regulatory requirements are met within department.
• Aids in the day-to-day operations of the department.
• Supports the company and its business services goals and core values.
• Performs other duties as assigned.

Requirements

• Licensed Practical Nurse (LPN) diploma.
• 3 years of hospital based experience in the delivery of patient care.

Qualifications

• Preferred - Ambulatory Experience.

Skills and Abilities

• Proficiency in using computers, software, and web-based applications.
• Effective verbal and written communication skills and ability to present information clearly and professionally.
• Excellent customer service skills and ability to gather and disseminate information with a diverse range of people, either in person or over the phone.
• Excellent interpersonal skills including and ability to work collaboratively with other departments and functional areas and handle high-pressure, difficult situations.
• Good organizational and time management skills and ability to work with minimal supervision.
• Excellent decision making, critical thinking, and analytical skills and ability to pay strong attention to detail.
• Proficiency in application of medical necessity criteria, standards of practice, and research regarding pre-certification guidelines.
• Working knowledge of terminology associated with CPT and ICD-10 coding, Medicare guidelines, HMO and PPO contracts and other insurance billing processes.

Pay

TBD

Schedule

TBD

Benefits

TBD