Job description

GENERAL DESCRIPTION

The Prior Authorization and Precertification Nurse (PA and Precert Nurse) is responsible for calling insurance companies to obtain a prior authorization and precertification for services, procedures and medications. In addition, the PA and Precert Nurse must be able to provide efficient and proficient services to our physicians as well as provide quality, courteous and compassionate services to our patients in adherence to the guidelines, policies and procedures set forth by The Conrad Pearson Clinic.

ESSENTIAL JOB FUNCTIONS

• Responsible for prior authorization and precertification of eligible medical services, procedures and medication.
• Ensure complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services.
• Call/navigate insurance websites for authorization requirements and obtain timely authorizations from various insurance companies.
• Communicate with insurance carriers, both internal and external customers and patients via phone or written correspondence.
• Update task in the system to include approvals, coinsurance, copay, deductibles and authorization requirements.
• Initiate appeals for denied authorizations.
• Prioritize incoming prior authorization and precertification requests according to urgency.
• Familiar with the practices and job duties at the Wolf River Clinic and all outlying clinics and is able and willing to work at these locations as needed.
• Communicate regularly with supervisor, keeping him/her apprised of all pertinent information and providing feedback.
• Ensure compliance for all regulatory requirements including OSHA, CLIA and HIPAA; immediately and accurately document and report occurrences to supervisor; and ensure compliance with all legal and regulatory requirements as outlined in the corporate compliance plan.
• Support and adhere to all company policies, procedures and management decisions; maintain confidentiality of patients’ medical information; and all confidential administrative related issues.
• Demonstrate dependability in attendance, punctuality in reporting for work and initiative in completing a full work schedule; meeting or exceeding all established deadlines and utilizing all resources and supplies efficiently and appropriately.
• Demonstrate the ability to concentrate during the course of the day.
• Display a positive outlook with a helpful, constructive manner when working with other employees.
• Demonstrate superior patient relations and interpersonal skills; demonstrate an appropriate level of mental and emotional tolerance and even temperament when dealing with staff, patients and general public using tact, sensitivity and sound judgment; promote a positive work environment and contribute to the overall efforts of the department and the company.

POSITION REQUIREMENTS

• Completion of a nursing program from an accredited school is required.
• Current Registered Nurse (RN) or Licensure Practical Nurse (LPN) is required.
• Two years of clinical experience, preferably in a urology practice is required.
• Excellent oral and written communication, interpersonal, problem solving and organizational skills are required.
• Occasional overtime, evening and weekend work is required.
• A valid driver’s license, dependable automobile and current auto insurance are required for occasional travel for business purposes and to work at satellite locations.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Experience:

• Nursing: 2 years (Required)

License/Certification:

• BLS Certification (Preferred)
• RN or LPN License (Preferred)

Work Location: One location

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