Revenue Cycle Precertification Nurse - LPN - Full Time - Monday - Friday 8am - 5pm - Benson Tower/Work From Home

Join Ochsner Health

We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record broken, and every patient helped is because of the dedicated employees who fill our hallways.

At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come make a difference at Ochsner Health and discover your future today!

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.

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)

• Must have computer skills and dexterity required for data entry and retrieval of information.
• Effective verbal and written communication skills and the ability to present information clearly and professionally.
• Must be proficient with Windows-style applications, various software packages specific to role and keyboard.
• Excellent customer service skills including the ability to gather and disseminate information with a diverse range of people, either in person or over the phone.
• Excellent interpersonal skills including the ability to work collaboratively with other departments and functional areas and the ability to handle high-pressure, difficult situations.
• Good organizational and time management skills including the ability to work with minimal supervision.
• Excellent decision making and critical thinking skills.
• Good analytical skills with a strong attention to detail.
• Proficiency in application of medical necessity criteria, standards of practice, and research regarding precertification guidelines.
• Ability to prioritize tasks and manage multiple tasks with efficiency and quality.
• Working knowledge and use and 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.

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 negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.

Normal routine involves no exposure to blood, body fluid or tissue, but exposure or potential for exposure may occur.

The incumbent may work with patients who have known or suspected communicable diseases and may enter isolation rooms. The incumbent has an occupational risk for exposure to all communicable diseases.

Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.