Insurance Utilization Nurse - LPN
Job Description
Department
Patient Registration
Job Summary
Responsible for gathering demographic and clinical information on all patients presenting for admission/observation, while utilizing nursing skills for clinical appropriateness, and communicates in a timely manner with managed care and other third party payors to establish ongoing authorization for patient care services. Also responsible for providing information, guidance and support to the Case Management team relative to payor specific process and/or expectations, as well as, acts as a liaison between payors and the medical management team in responses to payor issues.
Required Qualifications
• Require graduation from an accredited school of practical nursing.
• Require a minimum of two (2) years of experience working in a medical/hospital environment, as well as experience utilizing commonly used computer applications.
Preferred Qualifications
• Prefer typing skills minimum thirty (30) words per minute.
• Prefer working knowledge of ICD-9/ ICD-10 and CPT coding.
• Prefer working knowledge of UB04 and HCFA billing practices.
• Prefer working knowledge of Medicaid, Managed Care, and Third Party reimbursement.
• Prefer knowledge of Interqual and Milliman for inpatient medical necessity criteria.
• Prefer knowledge of Medicaid’s eQhealth system.
• Prefer demonstrated excellent customer service skills and phone etiquette skills.
• Prefer general knowledge of medical terminology.
• Prefer the ability to communicate clearly and effectively; excellent written skills and spelling/grammar.
• Prefer experience in patient interviewing.
• Prefer prior customer-centered service with demonstrated experience and ability to be flexible with changing priorities, demands and requests.
• Prefer demonstrated flexibility and adaptability.
• Prefer strong organizational skills.
Mandatory Education
HS EQ: High School Diploma, GED or Certificate
Preferred Education
AD: Associate's Degree
Required License And Certs
Preferred License and Certs
Hospitals and Health Care
Health Care Provider
Full-time