What are the responsibilities and job description for the Preservice Registered Nurse - Pre-Surgery, Providence Hospital position at University of South Alabama Health System?
Overview
USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists and researchers provide the region's most advanced medicine at multiple facilities, campuses, clinics and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall wellbeing of our community.
Responsibilities
The Pre Service RN is responsible for pre service operations including eligibility, authorization and pre-registration. across the health system including surgery, diagnostics and infusions; assists the manager with denials, training and education; verifies insurance for scheduled procedures prior to submission for authorization; reviews, analyzes and submits required clinical information to insurance payers for pre-treatment authorizations; makes recommendations to meet payer, regulatory and quality standards; stays up-to-date on insurance payer medical policies, payer specific clinical certification/referral requirements and acts as expert resources for clinical staff in these areas; obtains timely insurance certification by clearly and concisely communicating the pertinent clinical data to the insurance payer regarding the physician’s documented medical necessity; collaborates with all members of the patient care team to resolve insurance certification/referral issues in a timely manner; facilitates the resolution of denials and appeals relating to medical necessity by collaborating with physicians, pharmacists, department directors and management; documents certification process and authorization number information correctly and timely in the computer system to facilitate accurate concurrent review; assists as needed with review of Revenue Cycle and assists with development of policies and procedures; coordinates with other departments in the health system to provide quality patient services; ensures smooth and efficient pre-registration functions by expediting problems; ensures accurate information is being collected and entered correctly to the HSIS system; confirms that all insurance benefits meets standards of admission as dictated by policy; assists with the training of new employees, and the ongoing education and training of employees to ensure compliance; demonstrates sound judgement and ability to make effective decisions; adheres to departmental and hospital policies, including the ability to process and maintain confidential patient and business information; communicates and uses appropriate customer relation skills with administrative and departmental staff, technical staff, physicians, nurses, patients, families, other hospital staff and vendors in person, via email and by telephone; regular and prompt attendance; ability to work schedule as defined and overtime as required; related duties as required.
Employees must be in a regular position, working 20 hours or more per week (.50 FTE or greater) to qualify for benefits.
Qualifications
Graduation from an accredited school of nursing meeting the minimum standards set by the state of Alabama, one year of professional nursing experience and licensure with the state of Alabama as a registered nurse.