Service Access Nurse - Oncology Durham, NC

About the role

Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States.

Responsibilities

• Evaluate appropriate level of patient care, utilizing expert level clinical decision making to determine severity of illness for all elective, urgent and emergent admissions.
• Coordinate with patient, physicians, nursing and/or clinical staff when requirements of admission are not met/authorized, requiring facilitation of alternative care arrangements, physician/administrative override, or delay in service.
• Collect accurate and viable patient insurance information, and escalate all self-pay patients through the appropriate financial screening process (i.e. POMC, Medicaid, Charity Care, patient liability).
• Determine that referral authorizations, prior approval of specific treatments and surgical procedures, and second surgical opinions of specific treatment/surgical procedures have all been secured.
• Analyze clinical and financial information received on proposed admissions for coding accuracy, difficulty in obtaining authorization, and potential for financial issues.
• Initiate and facilitate pre-admission and pre-certification authorizations, requiring the detailed evaluation of clinical documentation.
• Ensure all scheduled surgical cases are reconciled with the appropriate billing system.
• Ensure inpatient vs. outpatient scheduling criteria are met in accordance with published payer CPT lists.
• Enter detailed documentation of actions and outcomes in applicable billing system.
• Analyze clinical and financial information received on proposed admissions for coding accuracy, difficulty in obtaining authorization, and potential for financial issues.
• Initiate and facilitate pre-admission and pre-certification authorizations, requiring the detailed evaluation of clinical documentation.
• Ensure all scheduled surgical cases are reconciled with the appropriate billing system.
• Ensure inpatient vs. outpatient scheduling criteria are met in accordance with published payer CPT lists.
• Enter detailed documentation of actions and outcomes in applicable billing system.
• Conduct denial appeal follow-up, through analysis of clinical documentation to support level of care provided and secure reimbursement.
• Provide quality assurance reviews of Pre-Registration staff work, ensuring internal controls are met.
• Trainer and preceptor of Pre-Registration staff in ensuring their clinical knowledge needed to fulfill their position responsibilities.
• Expert in medical terminology and clinical data interpretation.
• Liaison to all hospital and PDC departments and their staff members, including physicians, clinical nurses, Patient Resource Managers, clinic staff and bed control.
• Liaison to Patient Service Representatives, Billers, Collectors, internal and external Case Managers/Patient Resource Managers, Social Workers, and Discharge Planners.

Requirements

• B.S. in Nursing required.
• 3 years of nursing experience.

Skills and Abilities

• Excellent communication skills; written and verbal.
• Excellent customer service skills, including phone etiquette.
• Ability to establish good working relationships with associate departments.
• Working knowledge of ICD-9/CPT-4 coding.

Knowledge

• Medical terminology and clinical data interpretation.
• Liaison to all hospital and PDC departments and their staff members.