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 University Health System

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

📚 Education

💰 $129.6k Grant on 2022-12

Healthcare • Education

Duke University Health System is an academic health system (branded Duke Health) that delivers clinical care, patient services, research and education across multiple integrated divisions. Its offerings include clinical laboratories, primary care, homecare & hospice, patient revenue management, health technology solutions, and transport services such as Duke Life Flight. The organization emphasizes advancing health through patient care, workforce development, and innovation—summarized by its mission “Advancing Health Together”—and is recognized for safety, quality, and employer culture.

📋 Description

• Manage the patient intake process, including triage and admissions, for non-critical transfers into Duke University Health System. • Evaluate the appropriate level of care for elective, urgent, and emergent admissions using expert clinical decision-making. • Coordinate with patients, physicians, nursing, and clinical staff when admission requirements are not met or authorized. • Facilitate alternative care arrangements, physician or administrative overrides, and service delays as needed. • Collect accurate 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 review. • Reconcile scheduled surgical cases with the appropriate billing system. • Ensure inpatient versus outpatient scheduling criteria comply with payer CPT lists. • Document actions and outcomes in the applicable billing system. • Serve as a health system resource for ICD-9, CPT-4, DRG, and APC coding and assignment. • Train and precept Pre-Registration staff and conduct quality assurance reviews. • Follow up on denial appeals by analyzing clinical documentation to support the level of care and reimbursement. • Serve as a clinical and healthcare financial resource to the Patient Revenue Management Organization and health system. • Act as liaison to hospital, PDC, physician, nursing, patient resource, billing, collections, case management, social work, and discharge planning teams. • 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

🏖️ Benefits

• Relocation Assistance (based on eligibility) • Magnet organization environment • Nursing certification advocacy and support • Quality of Life: Living in the Triangle