[Hiring] Revenue Cycle Precertification Nurse @Ochsner Health

Role Description

This job ensures the financial security of scheduled inpatient and outpatient (excluding ED) 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.

• Coordinates with physician and/or staff for appropriate level of care setting and essential clinical documentation to support medical necessity of services ordered.
• Works collaboratively with Case Management to establish level of care for direct admits and inpatient stays.
• Acts as a resource for the Revenue Cycle staff within Pre-Service.
• Performs duties under general supervision and following moderately complex procedures and guidelines.

Qualifications

• Required - Licensed Practical Nurse (LPN) diploma.
• Required - 3 years of hospital-based experience in the delivery of patient care.
• Preferred - Ambulatory experience.
• Required - Current LPN license in the state of practice.

Requirements

• 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 the 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 with strong attention to detail.
• Proficiency in application of medical necessity criteria, standards of practice, and research regarding pre-certification guidelines.
• Ability to prioritize tasks and manage multiple tasks with efficiency and quality.
• Working knowledge of terminology associated with CPT and ICD-10 coding, Medicare guidelines, HMO and PPO contracts, and other insurance billing processes.

Job Duties

• 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 the department.
• Assists in the day-to-day operations of the department.
• Consistently supports the company and its business services goals and core values.
• Performs other duties as assigned.

Physical and Environmental Demands

• Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly.
• Normal routine involves no exposure to blood, body fluid or tissue, but exposure or potential for exposure may occur.
• The incumbent may work with patients who have known or suspected communicable diseases and may enter isolation rooms.
• The incumbent has an occupational risk for exposure to all communicable diseases.
• There may be occupational risk for exposure to hazardous medications or hazardous waste within the environment.