Revenue Cycle Precertification Nurse- RN- Benson Tower- Remote

Ochsner Health•New Orleans, LA

1d•Remote

About The Position

We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways. At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come make a difference at Ochsner Health and discover your future today! This job ensures the financial security of scheduled inpatient and outpatient (excluding ED) accounts for 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 and works collaboratively with Case Management to establish level of care for direct admits and inpatient stays. Also acts as a resource for the Revenue Cycle staff within Pre-Service and performs duties under general supervision and following moderately complex procedures and guidelines. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties. This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company's discretion.

Requirements

Graduate of an accredited school of nursing.
1 year Hospital based experience in the delivery of patient care
Current RN license in the state of practice
Must have computer skills and dexterity required for data entry and retrieval of patient information.
Must be proficient with Windows-style applications and keyboard.
Effective verbal and written communication skills and the ability to present information clearly and professionally to varying levels of individuals.
Demonstrates Good Judgement and conflict resolution skills.
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 difficult situations with professionalism.
Sound judgment in handling/escalating difficult situations.
Good organizational and time management skills including the ability work with minimal supervision.
Excellent decision making and critical thinking skills.
Good analytical skills with a strong attention to detail.
Proficiency in application of medical necessity criteria, standards of practice, and research regarding precertifcation guidelines.
Working knowledge and use of terminology associated with CPT and ICD-10 coding, Medicare guideline, HMO and PPO contracts and other insurance billing processes.

Nice To Haves

Bachelor’s degree in nursing.

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.
Assists in the day-to-day operations of the department.
Consistently supports company and Business Services Goals and Core Values.
Performs other related duties as required.
Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.
This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns.
The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

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