Revenue Cycle Precertification Nurse- LPN- Remote

Ochsner Clinic Foundation•New Orleans, LA

2d•Remote

About The Position

The Revenue Cycle Precertification Nurse ensures the financial security of scheduled inpatient and outpatient accounts, excluding emergency department accounts, by obtaining or initiating prior authorization for ordered services based on payer requirements after benefits and eligibility have been determined. The role coordinates with physicians and staff to obtain the appropriate level of care setting and clinical documentation supporting medical necessity, and works with Case Management to establish levels of care for direct admissions and inpatient stays. The nurse also serves as a resource for Revenue Cycle staff within Pre-Service and performs duties under general supervision using moderately complex procedures and guidelines. The position requires an LPN diploma, three years of hospital-based patient-care experience, and a current LPN license in the state of practice. Ambulatory experience is preferred. The role is remote, subject to geographic eligibility restrictions listed in the posting. Physical demands are classified as Light Work, with potential occupational exposure risks associated with working in a healthcare setting.

Requirements

Licensed Practical Nurse (LPN) diploma.
Three years of hospital-based experience in the delivery of patient care.
Current LPN license in the state of practice.
Proficiency using computers, software, and web-based applications.
Effective verbal and written communication skills, with the ability to present information clearly and professionally.
Strong customer service and information-gathering skills when interacting with diverse people in person or over the phone.
Strong interpersonal skills and ability to collaborate across departments and handle high-pressure, difficult situations.
Good organizational and time-management skills and ability to work with minimal supervision.
Decision-making, critical-thinking, analytical, and attention-to-detail skills.
Proficiency applying medical necessity criteria, standards of practice, and research regarding precertification guidelines.
Ability to prioritize and manage multiple tasks efficiently and with quality.
Working knowledge of CPT and ICD-10 terminology, Medicare guidelines, HMO and PPO contracts, and other insurance billing processes.

Nice To Haves

Ambulatory experience.

Responsibilities

Secure clinical documentation and perform pre-service medical necessity reviews to obtain prior authorizations.
Coordinate with physicians and staff to determine the appropriate level of care setting and obtain clinical documentation supporting medical necessity.
Collaborate with Case Management to establish levels of care for direct admissions and inpatient stays.
Serve as a resource for Revenue Cycle staff within Pre-Service.
Maintain professional and technical knowledge and certifications.
Ensure regulatory requirements are met within the department.
Assist with the day-to-day operations of the department.
Support the company's business services goals and core values.
Remain knowledgeable about applicable laws, accreditation standards, and regulatory requirements, and ensure compliance.
Report known or suspected unethical or questionable conduct and patient or employee safety, privacy, or other compliance concerns.
Perform other duties as assigned.