Service Access Nurse – Inpatient/Surgery Preservice Verification

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

📋 Description

• Oversee the patient intake procedure, encompassing patient triage and admissions for non-critical transfer patients into Duke University Health System.

• Assess the suitable level of patient care by utilizing expert clinical judgment for elective, urgent, and emergent admissions.

• Review patient clinical data and create precise assessments.

• Collaborate with patients, physicians, nursing, and clinical staff when admission criteria are unmet or not authorized.

• Organize alternative care options, physician/administrative overrides, or service delays as required.

• Gather accurate patient insurance details and escalate self-pay patients through financial screening procedures.

• Coordinate referral authorizations, approvals for treatment and surgical procedures, and second surgical opinions.

• Evaluate clinical and financial data for coding accuracy, authorization challenges, and potential financial concerns.

• Initiate and facilitate pre-admission and pre-certification authorizations through a thorough evaluation of clinical documentation.

• Reconcile scheduled surgical cases with the relevant billing system.

• Ensure compliance with inpatient versus outpatient scheduling criteria according to published payer CPT lists.

• Document actions and outcomes comprehensively in applicable billing systems.

• Act as a resource for the health system concerning ICD-9 diagnoses/procedures, CPT-4 procedures, DRG, and APC assignments.

• Train and mentor Pre-Registration staff while conducting quality assurance reviews.

• Handle denial appeal follow-ups by analyzing clinical documentation to support care levels and secure reimbursement.

• Serve as a clinical and healthcare financial resource for PRMO and the wider health system.

• Coordinate with hospital and PDC departments, physicians, clinical nurses, Patient Resource Managers, clinic staff, bed control, billing and collections personnel, case managers, social workers, and discharge planners.

• Perform additional related duties as needed.

⛳️ Requirements

• BSN degree is mandatory.

• Minimum of 3 years nursing experience is required.

• NC or compact state nursing license is necessary.

• Exceptional written and verbal communication abilities.

• Outstanding customer service skills, including professional phone etiquette.

• Capability to build strong working relationships with associated departments.

• Familiarity with ICD-9/CPT-4 coding is essential.

• In-depth knowledge of medical terminology and clinical data interpretation.

• Expertise in clinical decision-making and patient assessment.

• Understanding of patient intake, triage, admissions, pre-admission authorization, and pre-certification processes.

🏝️ Benefits

• Relocation Assistance (subject to eligibility).

• An Equal Opportunity Employer committed to providing employment opportunities without discrimination based on protected characteristics.

• Information and provisions available for reasonable accommodations.