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

Duke; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

Duke University Health System seeks an experienced Service Access Nurse within the Patient Revenue Management Office to manage intake and triage for non-critical transfers, ensuring appropriate care and thorough financial screening. This role involves coordinating with physicians, nurses, and administrative staff to secure authorizations and referrals.

The position emphasizes accurate data capture, coding awareness, and collaboration across departments to optimize patient flow and reimbursement.

Qualifications

• Excellent communication skills, written and verbal.
• Working knowledge of ICD-9/CPT-4 coding.
• Ability to establish good working relationships with associate departments.

Responsibilities

• Assess admission eligibility and level of care for elective, urgent, and emergent admissions.
• Coordinate with physicians and staff when requirements are not met or require overrides.
• Collect accurate patient insurance information and escalate self-pay patients through financial screening.
• Ensure required referrals, pre-authorizations, and second opinions are secured for admissions.
• Analyze clinical and financial data for coding accuracy and reimbursement potential.
• Document actions and outcomes in the billing system and coordinate with billing teams.

Skills

Communication skills

ICD-9/CPT-4 coding

Customer service

Education

BSN

Tools

Billing systems

Job description

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. No matter where your talents lie, join us and discover how we can advance health together.

Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.

Duke Nursing Highlights:

• Duke UniversityHealth System is designated as a Magnet organization
• Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 Nurses.
• Duke University Health System was awarded the American Board of Nursing Specialties Award for Nursing Certification Advocacy for being strong advocates of specialty nursing certification.
• Duke University Health System has 6000 + registered nurses
• Quality of Life: Living in the Triangle!
• Relocation Assistance (based on eligibility)

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.

Job Summary

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.

Work Performed

• 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.

Knowledge, Skills and Abilities

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.

Minimum Qualifications

Education

BSN Required

Experience

3 years of nursing experience

Degrees, Licensures, Certifications

NC or compact state license

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions:

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.