LVN Pre/Authorization Nurse Auditor -$21.44 -$25.00
Work Schedule : 8am to 4:30 pm or 8:30 am to 5:00pm
Location: 610 South and Almeda Rd
- Obtains authorizations for scheduled outpatient appointments, special procedures, tests, injections and higher level services.
- Provides pertinent clinical information in a timely manner according to third party payer guidelines.
- Evaluates the medical necessity for inpatient hospital admission and Outpatient appointments reviews the authorization of the services or admission along with the estimated length of stay utilizing nationally recognized screening criteria.
- Identifies issues that are impacting initial, continued stay, high level service and outpatient service authorizations.
- Facilitates peer to peer review between the clinical staff and they payer for denied admissions/length of stay and outpatient services.
- Participates in monthly departmental payer Provider Representative meetings.
- Maintains all authorization information on the Auth/Cert screens in EPIC. Information is to be specific enough to assist in the tracking and managing of denials.
- Retrieves medical record information or any other clinical information needed for appealing the claim or denial of services
- Participates in required Authorization education.
- Interacts with all levels of clinical and administrative staff when addressing issues impacting inpatient denials.
- Logs and maintains all denials on the Nurse Audit Log by recording the specific data associated by the data fields.
- Handles all other special projects for Manager, or Director of Operations of Patient Financial Services as requested such as representing her in internal and external meetings.
- Volunteers as a team members for special projects and ensure they complete these projects or assignments as needed.
- Ensures that the employees of the department have current up-to-date policies and procedures that will assist them in meeting their goals.
- Ensures that the team members are responsible for assisting co-workers during heavy workloads and that they utilize their free time to complete tasks necessary to meet departmental/Harris Health System needs.
- Ensures that existing and new work queues are worked appropriately.
Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program
1-3 years of hospital or medical clinic experience.
Required License, Certification, Association: Active - Licensed Vocational Nurse (LVN) or LPN
Updated by V.G - 7.9.2018