Service Access Nurse - Inpatient/Surgery Preservice Verification (100% Remote Position

Duke Careers•Durham, NC

4d•Remote

About The Position

Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire an experienced Service Access Nurse who will embrace our mission of Advancing Health Together. This is a 100% remote position. At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. The Patient Revenue Management Organization (PRMO) is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle, including scheduling, registration, coding, billing, and other essential revenue functions for Duke Health. Duke University Health System is a Magnet organization, and its nurses are consistently recognized. Duke University Health System has over 6000 registered nurses.

Requirements

BSN Required
3 years of nursing experience
NC or compact state license
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.
Expert in medical terminology and clinical data interpretation.

Responsibilities

Manage patient intake process (including patient triage and admissions) for non-critical transfer patients into Duke University Health System from referring hospitals, clinics, and physicians offices, ensuring appropriate level of care and financial screening.
Evaluate appropriate level of patient care, utilizing expert level clinical decision making to determine severity of illness for all elective, urgent and emergent admissions. Requires expert level analysis of patient clinical information and formulation of an accurate assessment of the patient and his/her condition.
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.
Responsible for collecting accurate and viable patient insurance information, and escalating all self-pay patients through the appropriate financial screening process (i.e. POMC, Medicaid, CharityCare, patient liability).
Coordinate with physician, nursing and/or clinical staff in determining that the following have all been secured: (1) referral authorizations,(2) prior approval of specific treatments and surgical procedures, and(3) second surgical opinions of specific treatment/surgical procedures.
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.
Responsible for ensuring 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.
Health System resource for coding of ICD-9 diagnoses/procedures, CPT-4 procedures, DRG, & APC assignment.
Trainer and preceptor of Pre-Registration staff in ensuring their clinical knowledge needed to fulfill their position responsibilities.
Provide quality assurance reviews of Pre-Registration staff work, ensuring internal controls are met.
Conduct denial appeal follow-up, through analysis of clinical documentation to support level of care provided and secure reimbursement.
Clinical and health care financial resource to PRMO and broader health system membership.
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.
Perform other related duties incidental to the work described herein.