Revenue Cycle Precertification Nurse – LPN

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Obtain clinical documentation and conduct pre-service medical necessity reviews to secure prior authorizations.

• Ensure the financial integrity of scheduled inpatient and outpatient accounts, excluding emergency department cases, by securing or initiating prior authorizations in line with payer requirements.

• Collaborate with physicians and staff to determine the appropriate level of care and ensure supporting clinical documentation for medical necessity.

• Work alongside Case Management to define the level of care for direct admissions and inpatient stays.

• Act as a resource for Revenue Cycle staff within the Pre-Service department.

• Execute responsibilities under general supervision and following moderately complex procedures and guidelines.

• Maintain professional certifications and technical knowledge.

• Ensure compliance with all departmental regulatory standards.

• Assist in the daily operations of the department.

• Uphold the company’s business service objectives and core values.

• Adhere to all applicable laws, regulations, accreditation standards, and regulatory requirements.

• Report any known or suspected unethical behavior and any concerns regarding patient, employee safety, privacy, or compliance.

• Carry out additional tasks as assigned.

⛳️ Requirements

• Diploma as a Licensed Practical Nurse (LPN).

• Minimum of 3 years of hospital-based experience in patient care delivery.

• Current LPN license in the relevant state of practice.

• Ambulatory experience is preferred.

• Proficient in using computers, software, and web applications.

• Strong verbal and written communication abilities.

• Capability to present information clearly and professionally.

• Exceptional customer service skills.

• Ability to gather and communicate information effectively with diverse individuals, both in person and over the phone.

• Strong interpersonal and collaborative skills.

• Capacity to manage high-pressure and challenging situations.

• Good organizational and time management abilities.

• Ability to work with minimal supervision.

• Proficient decision-making, critical thinking, analytical skills, and attention to detail.

• Experience in applying medical necessity criteria, practice standards, and researching pre-certification guidelines.

• Ability to prioritize and manage multiple tasks efficiently while maintaining quality.

• Familiarity with CPT and ICD-10 terminology, Medicare guidelines, HMO and PPO contracts, and insurance billing processes.

• Stay informed about relevant federal, state, and local laws, accreditation standards, and regulatory requirements.

• Ability to adhere to the employer’s Compliance & Privacy Program and Standards of Conduct.

🏝️ Benefits

• Full-time employment.

• Equal opportunity employer.

• Reasonable accommodations for individuals with disabilities.

• Accessibility support and application accommodations.