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 triage and admissions for non-critical transfers into Duke University Health System.

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

• Collaborate with patients, physicians, nursing, and clinical staff when admission prerequisites are unmet or unauthorized.

• Enable alternative care solutions, physician or administrative overrides, and service delays as required.

• Gather precise insurance details and escalate self-pay patients through financial screening protocols.

• Coordinate referral authorizations, approvals for treatments and surgical procedures, as well as second surgical opinions.

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

• Initiate and manage pre-admission and pre-certification authorizations via thorough clinical documentation examination.

• Reconcile scheduled surgical procedures with the correct billing system.

• Ensure compliance of inpatient versus outpatient scheduling criteria with payer CPT lists.

• Document actions and results in the relevant billing system.

• Act as a resource within the health system for ICD-9, CPT-4, DRG, and APC coding and classification.

• Educate and mentor Pre-Registration staff and perform quality assurance evaluations.

• Follow up on denial appeals by reviewing clinical documentation to substantiate the level of care and reimbursement.

• Serve as a clinical and healthcare financial resource to the Patient Revenue Management Organization and the health system.

• Function as a liaison among hospital, PDC, physicians, nursing, patient resources, billing, collections, case management, social work, and discharge planning teams.

• Carry out other related responsibilities incidental to the tasks described.

⛳️ Requirements

• Bachelor of Science in Nursing (BSN) required

• Three years of nursing experience

• NC or compact state nursing license

• Exceptional written and verbal communication capabilities

• Outstanding customer service skills, including proficiency in phone etiquette

• Ability to foster positive working relationships with associate departments

• Practical knowledge of ICD-9/CPT-4 coding

• In-depth understanding of medical terminology and clinical data interpretation

🏝️ Benefits

• Relocation Assistance (subject to eligibility)

• Environment of a Magnet organization

• Advocacy and support for nursing certification

• Quality of Life: Residing in the Triangle