Licensed Vocational Nurse (LVN) Or RN
We are seeking 1 LVN Pre/Authorization Nurse Auditor OR an RN with a minimum 6 months of utilization review, coding/billing, or authorization/case management experience.
JOB SUMMARY: Works as part of integrated team and is involved in reviews of authorization requests and communicates with the physicians and clinic when additional information is needed or assists clinical practitioners office in re-directing care to an appropriate plan provider or facility. Performs activities that include obtaining payer authorization for outpatient services that require notification/authorization based on payer specific guidelines. Responsible for clinical part of audit to determine if all charges have been captured appropriately. Maintains a thorough understanding of the plans provider contracts, authorization requirements and Interqual Criteria Provides ongoing follow-up and re-evaluation of clinical departments/areas as requested or needed for authorization review. Performs prior authorization and retrospective clinical review according to Interqual Criteria, Medicare Guidelines and established payer protocols to determine the medical appropriateness of ordered pre and post scheduled services. Enters authorization information into EPIC and maintains authorization data
Nurse in good standing, currently licensed in the State of Texas without stipulations in practice as an Licensed Vocational Nurse
Minimum 6 months of utilization review, coding/billing, or authorization/case management experience (required).
Familiarity with hospital coding and billing processes.
Knowledge of Interqual/Milliman guidelines (preferred).
EPIC EMR experience (preferred).
Experience in various clinical areas (preferred).
Work Hours: Monday Friday 8a.m. 5p.m.
Duration: Contract to Hire
Location: Med Center (Close to NRG stadium)Company Description
Since 1989 Resource Staffing has provided professional staffing services to premier businesses in the Houston, Austin, San Antonio and Dallas areas. Our reputation for integrity, respect, and accountability has been earned through an unwavering determination to provide the best possible service for you and your company, no matter how big or small your needs are.
The Right people, Right now