LVN Pre/Authoriz Nurse Auditor

Harris Health System Harris Health System is the public healthcare safety‑net provider established in 1966 to serve the residents of Harris County, Texas. Job Details Job Number: 179051 Job Title: LVN Pre/Authoriz Nurse Auditor Salary: $28.97 - $36.93 Job Summary Works as part of an integrated team and is involved in reviews of authorization requests, communicating with physicians and clinics when additional information is needed, or assisting clinical practitioner’s 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 the clinical part of audit to determine whether 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. Minimum Qualifications Nurse in good standing, licensed in the state of Texas as a Licensed Vocational Nurse. Minimum 3 years of hospital experience in various clinical areas (required). 1 year utilization review, authorization or case management experience (preferred). Familiarity with hospital coding and billing processes (preferred). Knowledge of Interqual/Milliman guidelines (preferred). EPIC EMR experience (preferred). Management experience: Preferred but not necessary. Equipment operated: PC functions, calculator, general office equipment. Special Requirements Communication Skills: Above average verbal (heavy public contact), exceptional verbal (public speaking). Writing/Composing (Correspondence/Reports). Other Skills: Analytical, mathematics, medical terms, P.C. Work schedule: Hybrid telecommuter. Other requirements: Requires travel to Harris Health System facilities. Must be able to interact successfully in a culturally diverse environment. #J-18808-Ljbffr Direct Jobs