Revenue Cycle Precertification Nurse- LPN

ochsner; New Orleans (LA); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Equal Opportunity Employer

Job summary

Ochsner is seeking a Licensed Practical Nurse to perform pre-service medical necessity reviews and obtain prior authorizations for inpatient and outpatient services. You will coordinate with physicians and staff to ensure appropriate level of care, maintain documentation, and support revenue cycle activities.

The role requires 3 years of hospital-based patient care experience, current LPN license in the state, and proficiency in medical terminology and electronic records.

Qualifications

• This position requires a licensed practical nurse with hospital experience.
• Strong clinical documentation and medical terminology knowledge.
• Ability to communicate clearly with patients and staff.
• Familiarity with payer guidelines and pre-certification processes.

Responsibilities

• Secures pre-service medical necessity reviews to obtain prior authorizations.
• Maintains professional knowledge and certifications; stays current with regulations.
• Ensures compliance with department regulatory requirements.
• assists in daily department operations and supports organizational goals.

Skills

LPN

Medical terminology

Customer service

Communication skills

Education

LPN diploma

Tools

EMR software

Job description

Exceptional care starts with exceptional people.

For us, this is more than a job- it's a calling. It's waking up each day, looking for ways to make a difference with a compassionate, inclusive and talented team. Ochsner empowers you to discover your passion, reach your potential, and Pursue Your Purpose. Exceptional care starts with exceptional people and teams. Together we are leading the way.

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 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.

Education

• Required - Licensed Practical Nurse (LPN) diploma.

Work Experience

• Required - 3 years of hospital based experience in the delivery of patient care.
• Preferred - Ambulatory experience.

Certifications

• Required - Current LPN license in the state of practice.

Knowledge Skills and Abilities (KSAs)

• 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 and 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 and ability to pay 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 guideline, 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 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.

The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.

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.

Physical and Environmental Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a ne