SERVICE ACCESS NURSE - OUTPATIENT MEDICATION AUTHORIZATION **100% Remote Position**
Duke University Health System
Location: Durham, North Carolina
Internal Number: 122795
PRMO:, established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke PrimaryCare. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Duke's reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance.
Duke Nursing Highlights:
Duke University Health System is designated as a Magnet® organization
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 Nurses.
Duke University Health System was awarded the American Board of Nursing Specialties Award for Nursing Certification Advocacy for being strong advocates of specialty nursing certification.
Duke University Health System has 6000 + registered nurses
Quality of Life: Living in the Triangle!
Duke University Health System - Patient Revenue Management Office (PRMO) seeks to hire an experienced Service Access Nurse who will embrace our mission of Advancing Health Together.
General Description of the Job Class
Manage patient intake process (including patient triage and admissions) for non-critical transfer patients into Duke University Health System from referring hospitals, clinics, and physicians offices, ensuring appropriate level of care and financial screening.
Duties and Responsibilities of this Level
Evaluate appropriate level of patient care, utilizing expert level clinical decision making to determine severity of illness for all elective, urgent and emergent admissions. Requires expert level analysis of patient clinical information and formulation of an accurate assessment of the patient and his/her condition.
Coordinate with patient, physicians, nursing and/or clinical staff when requirements of admission are not met/authorized, requiring facilitation of alternative care arrangements, physician/administrative override, or delay in service.
Responsible for collecting accurate and viable patient insurance information, and escalating all self-pay patients through the appropriate financial screening process (i.e. POMC, Medicaid, Charity Care, patient liability).
Coordinate with physician, nursing and/or clinical staff in determining that the following have all been secured: (1) referral authorizations, (2) prior approval of specific treatments and surgical procedures, and (3) second surgical opinions of specific treatment/surgical procedures.
Analyze clinical and financial information received on proposed admissions for coding accuracy, difficulty in obtaining authorization, and potential for financial issues .
Initiate and facilitate pre-admission and pre-certification authorizations, requiring the detailed evaluation of clinical documentation.
Responsible for ensuring all scheduled surgical cases are reconciled with the appropriate billing system.
Ensure inpatient vs. outpatient scheduling criteria are met in accordance with published payer CPT lists.
Enter detailed documentation of actions and outcomes in applicable billing system.
Health System resource for coding of ICD-9 diagnoses/procedures, CPT-4 procedures, DRG, & APC assignment.
Trainer and preceptor of Pre-Registration staff in ensuring their clinical knowledge needed to fulfill their position responsibilities.
Provide quality assurance reviews of Pre-Registration staff work, ensuring internal controls are met.
Conduct denial appeal follow-up, through analysis of clinical documentation to support level of care provided and secure reimbursement.
Clinical and health care financial resource to PRMO and broader health system membership.
Expert in medical terminology and clinical data interpretation.
Liaison to all hospital and PDC departments and their staff members, including physicians, clinical nurses, Patient Resource Managers, clinic staff and bed control.
Liaison to Patient Service Representatives, Billers, Collectors, internal and external Case Managers/Patient Resource Managers, Social Workers, and Discharge Planners.
Perform other related duties incidental to the work described herein.
Required Qualifications at this Level
3 years of nursing experience
Degrees, Licensure, and/or Certification
R.N. licensure and North Carolina State Licensure required
Knowledge, Skills, and Abilities
Excellent communication skills; written and verbal
Excellent customer service skills, including phone etiquette
Ability to establish good working relationships with associate departments
Working knowledge of ICD-9/CPT-4 coding
Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
As a world-class academic and health care system, Duke Health strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.