Revenue Cycle Precertification Nurse – LPN

🔥 4 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 10%

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Ochsner Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1942

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

💰 Grant on 2023-07

Healthcare • Healthcare Insurance • Non-profit

Ochsner Health is a comprehensive healthcare system dedicated to delivering health services to the people of Louisiana, Mississippi, and the Gulf South. Its mission is to serve, heal, lead, educate, and innovate in healthcare. As the largest academic medical center in Louisiana, Ochsner focuses on a clinically-integrated research program aimed at improving community wellness and educating future healthcare leaders. They offer a variety of services, including primary care, urgent care, women's and men's health, digital medicine, and specialized treatments such as cancer care, heart and vascular services, transplants, and more. Ochsner also emphasizes community engagement through partnerships, education, and outreach programs, while fostering an inclusive environment. They are committed to accessibility, patient stories, and transparency in billing and insurance information. Ochsner is a non-profit organization and an equal opportunity employer.

📋 Description

• Secure clinical documentation and perform pre-service medical necessity reviews to obtain prior authorizations • Ensure the financial security of scheduled inpatient and outpatient accounts, excluding ED accounts, by obtaining or initiating prior authorization based on payer requirements • Coordinate with physicians and staff regarding the appropriate level of care and clinical documentation supporting medical necessity • Collaborate with Case Management to establish the level of care for direct admissions and inpatient stays • Serve as a resource for Revenue Cycle staff within Pre-Service • Perform duties under general supervision and according to moderately complex procedures and guidelines • Maintain professional and technical knowledge and certifications • Ensure all departmental regulatory requirements are met • Assist with day-to-day department operations • Support company business-service goals and core values • Remain compliant with applicable laws, regulations, accreditation standards, and regulatory requirements • Report known or suspected unethical conduct and patient, employee safety, privacy, or compliance concerns • Perform other duties as assigned

🎯 Requirements

• Licensed Practical Nurse (LPN) diploma • 3 years of hospital based experience in the delivery of patient care • Current LPN license in the state of practice • Ambulatory experience preferred • Proficiency in using computers, software, and web-based applications • Effective verbal and written communication skills • Ability to present information clearly and professionally • Excellent customer service skills • Ability to gather and disseminate information with diverse people in person or over the phone • Excellent interpersonal and collaborative skills • Ability to handle high-pressure, difficult situations • Good organizational and time management skills • Ability to work with minimal supervision • Excellent decision-making, critical-thinking, analytical, and attention-to-detail skills • Proficiency in applying medical necessity criteria, standards of practice, and researching pre-certification guidelines • Ability to prioritize and manage multiple tasks efficiently and with quality • Working knowledge of CPT and ICD-10 terminology, Medicare guidelines, HMO and PPO contracts, and insurance billing processes • Ability to remain knowledgeable about applicable federal, state, and local laws, accreditation standards, and regulatory requirements • Ability to comply with the employer’s Compliance & Privacy Program and Standards of Conduct

🏖️ Benefits

• Full-time employment • Equal opportunity employment • Reasonable accommodations for individuals with disabilities • Accessibility support and application accommodations

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