Revenue Cycle Precertification Nurse-LPN

Exceptional care starts with exceptional people.

For us, this is more than a job– it’s a calling. It’s waking up each day, looking for ways to make a difference with a compassionate, inclusive and talented team. Ochsner empowers you to discover your passion, reach your potential, and Pursue Your Purpose. Exceptional care starts with exceptional people and teams. Together we are leading the way.

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.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.

This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company's discretion.
 

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)

• Proficiency in using computers, software, and web-based applications.

• Effective verbal and written communication skills and ability to present information clearly and professionally.

• Excellent customer service skills and ability to gather and disseminate information with a diverse range of people, either in person or over the phone.

• Excellent interpersonal skills including and ability to work collaboratively with other departments and functional areas and handle high-pressure, difficult situations.

• Good organizational and time management skills and ability to work with minimal supervision.

• Excellent decision making, critical thinking, and analytical skills and ability to pay strong attention to detail.

• Proficiency in application of medical necessity criteria, standards of practice, and research regarding pre-certification guidelines.

• Ability to prioritize tasks and manage multiple tasks with efficiency and quality.

• Working knowledge of 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.
 

Physical and Environmental Demands
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.

Are you ready to make a difference? Apply Today!

Ochsner Health does not consider an individual an applicant until they have formally applied to the open position on this careers website.

Please refer to the job description to determine whether the position you are interested in is remote or on-site. Individuals who reside in and will work from the following areas are not eligible for remote work position: Colorado, California, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Vermont, Washington, and Washington D.C.

Ochsner Health endeavors to make our site accessible to all users.  If you would like to contact us regarding the accessibility of our website, or if you need an accommodation to complete the application process, please contact our HR Employee Solution Center at 504-842-4748 (select option 1) or [email protected]. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.

Ochsner is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to any legally protected class, including protected veterans and individuals with disabilities.