Revenue Cycle Precertification Nurse- LPN- Remote

Ochsner Health•New Orleans, LA

4d•Remote

About The Position

This role ensures the financial security of scheduled inpatient and outpatient accounts, excluding emergency department accounts, by obtaining or initiating prior authorization for ordered services after benefits and eligibility have been determined. The nurse coordinates with physicians and staff to identify the appropriate level-of-care setting and secure clinical documentation supporting medical necessity. The role also collaborates with Case Management on level-of-care decisions for direct admits and inpatient stays, serves as a resource for Pre-Service Revenue Cycle staff, and performs duties under general supervision using moderately complex procedures and guidelines.

Requirements

Licensed Practical Nurse (LPN) diploma.
Three years of hospital-based experience delivering patient care.
Current LPN license in the state of practice.
Proficiency using computers, software, and web-based applications.
Effective verbal and written communication skills, including presenting information clearly and professionally.
Customer service skills and ability to gather and share information with diverse people in person or by phone.
Interpersonal skills to collaborate across departments and handle high-pressure, difficult situations.
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 pre-certification 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.
Ability to meet the physical demands of Light Work, including exerting up to 20 pounds occasionally and/or up to 10 pounds frequently.

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 regarding appropriate level-of-care settings and documentation supporting medical necessity.
Work collaboratively with Case Management to establish level of care for direct admits 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 day-to-day department operations.
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.