Prior Authorization Nurse, FT Days (54591) at EL PASO CHILDRENS HOSPITAL CORPORATION

El Paso, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

24 Mar, 26

Salary

0.0

Posted On

24 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Skills, Communication Skills, Detail Oriented, Critical Thinking, Problem Solving, Knowledge of Medicare Regulations, Knowledge of CPT Coding, Knowledge of ICD10 Coding, Knowledge of HCPCs, Ability to Multi-task, Knowledge of Computers, Knowledge of Software Applications, Service Orientation, Professionalism

Industry

Hospitals and Health Care

Description

Job Details Level: Experienced Job Location: El Paso Childrens Hospital - El Paso, TX 79905 Position Type: Full Time Education Level: 4 Year Degree Travel Percentage: None Job Shift: Day Job Category: Health Care Position Summary The Prior Authorization Nurse’s primary responsibilities are to perform the review requests for service authorizations in order to monitor continuity and coordination of care and to assist in the utilization of appropriate services. These reviews include selected specialties, medical treatments and services, elective hospital admissions, rehabilitative and ancillary services. Assist the complex cases and internal process development and interact closely with the Medical Directors and Prior Authorization Representatives to direct appropriate utilization and data captured. Qualifications Minimum Position Requirements Work Experience: Three (3) years of clinical nurse experience as Registered Nurse (RN) required. Experience in Emergency Room, Urgent Care, Clinic or hospital/provider office nursing. Knowledge of government and third-party payer reimbursement methodology. Healthcare operations experience, particularly in acute care hospital setting. License/Registration/Certification: Current RN License to practice in the State of Texas. Current Basic Life Support (BLS). Valid drivers license/proof of insurance. Education and Training: Bachelors of Science in Nursing. Skills: Must be able to work independently and possess strong clinical skills. Detail oriented, able to function under pressure and multi-task. Excellent communication skills, verbal and written. Knowledge of computers and all other office equipment. Working knowledge of software applications (i.e. MS Office, Word, Excel, etc.). Knowledge of Medicare regulations and federal Strong service orientation and professionalism. Must possess critical thinking and problem solving skills. Knowledge of CPT, HCPCs and ICD10 coding principles.

Responsibilities

The Prior Authorization Nurse is responsible for reviewing requests for service authorizations to ensure continuity and coordination of care. This includes assisting with complex cases and interacting with Medical Directors and Prior Authorization Representatives.