Service Access Nurse – Inpatient/Surgery Preservice Verification

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🌲 North Carolina – Remote

🌲 North Carolina – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Duke Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1924

💼 Consulting

🏥 Healthcare

📚 Education

Consulting • Healthcare • Education

Duke Careers is a platform connected to Duke University's rich legacy, established in 1924. It aims to celebrate the centennial of Duke University while providing resources, stories, and interviews that reflect the university's history, current achievements, and future aspirations. A key focus of Duke Careers is to engage with alumni and the community, showcasing the transformative impact of education and leadership within the university.

📋 Description

• Manage the patient intake process, including patient triage and admissions, for non-critical transfer patients into Duke University Health System • Evaluate the appropriate level of patient care using expert clinical decision-making for elective, urgent, and emergent admissions • Analyze patient clinical information and formulate accurate assessments • Coordinate with patients, physicians, nursing, and clinical staff when admission requirements are not met or authorized • Facilitate alternative care arrangements, physician/administrative overrides, or service delays when needed • Collect accurate patient insurance information and escalate self-pay patients through financial screening processes • Coordinate referral authorizations, treatment and surgical procedure approvals, and second surgical opinions • Analyze clinical and financial information for coding accuracy, authorization difficulty, and potential financial issues • Initiate and facilitate pre-admission and pre-certification authorizations through detailed clinical documentation evaluation • Reconcile scheduled surgical cases with the appropriate billing system • Ensure inpatient versus outpatient scheduling criteria meet published payer CPT lists • Enter detailed documentation of actions and outcomes in applicable billing systems • Serve as a health system resource for ICD-9 diagnoses/procedures, CPT-4 procedures, DRG, and APC assignment • Train and precept Pre-Registration staff and provide quality assurance reviews • Conduct denial appeal follow-up by analyzing clinical documentation to support level of care and secure reimbursement • Serve as a clinical and healthcare financial resource to PRMO and the broader health system • Liaise with hospital and PDC departments, physicians, clinical nurses, Patient Resource Managers, clinic staff, bed control, billing and collections staff, case managers, social workers, and discharge planners • Perform other related duties incidental to the work described

🎯 Requirements

• BSN required • 3 years of nursing experience • NC or compact state license • Excellent written and verbal communication skills • 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 knowledge of medical terminology and clinical data interpretation • Clinical decision-making and patient assessment expertise • Knowledge of patient intake, triage, admissions, pre-admission authorization, and pre-certification processes

🏖️ Benefits

• Relocation Assistance (based on eligibility) • Equal Opportunity Employer committed to providing employment opportunity without regard to protected characteristics • Reasonable accommodation information and provisions available