Preservice Registered Nurse - Pre-Surgery, Providence Hospital

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.

• Responsible for pre service operations including eligibility, authorization and pre-registration across the health system including surgery, diagnostics and infusions.
• Assist the manager with denials, training and education.
• Verify insurance for scheduled procedures prior to submission for authorization.
• Review, analyze and submit required clinical information to insurance payers for pre-treatment authorizations.
• Make recommendations to meet payer, regulatory and quality standards.
• Stay up-to-date on insurance payer medical policies, payer specific clinical certification/referral requirements and act as an expert resource for clinical staff in these areas.
• Obtain timely insurance certification by clearly and concisely communicating pertinent clinical data to the insurance payer regarding the physician’s documented medical necessity.
• Collaborate with all members of the patient care team to resolve insurance certification/referral issues in a timely manner.
• Facilitate the resolution of denials and appeals relating to medical necessity by collaborating with physicians, pharmacists, department directors and management.
• Document certification process and authorization number information correctly and timely in the computer system to facilitate accurate concurrent review.
• Assist as needed with review of Revenue Cycle and with the development of policies and procedures.
• Coordinate with other departments in the health system to provide quality patient services.
• Ensure smooth and efficient pre-registration functions by expediting problems; ensure accurate information is collected and entered correctly into the HSIS system; confirm that all insurance benefits meet standards of admission as dictated by policy.
• Assist with the training of new employees, and the ongoing education and training of employees to ensure compliance.
• Demonstrate sound judgement and the ability to make effective decisions; adhere to departmental and hospital policies, including the processing and maintaining of confidential patient and business information.
• Communicate and use 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.
• Maintain regular and prompt attendance; work schedule as defined and overtime as required; perform related duties as required.

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.

The University of South Alabama is an Equal Opportunity Employer and does not discriminate on the basis of race, color, national origin, sex, pregnancy, sexual orientation, gender identity, gender expression, religion, age, genetic information, disability, protected veteran status or any other applicable legally protected basis.

Employees must be in a regular position, working 20 hours or more per week (.50 FTE or greater) to qualify for benefits.