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LVN Nurse Auditor- Galleria Area

Houston Galleria, TX

Posted: 08/30/2019 Industry: Office Administration Job Number: 145521.10 Pay Rate: $20-29/hr.

Client in Galleria Area in need of LVN.

Position is temp to hire

Pay rate:$25-29/hr.

Hours are Monday-Friday 8-5.

Job Duties:

  1. 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 practitioner office in re-directing care to an appropriate plan provider or facility. -
  2. Performs activities that include obtaining payer authorization for outpatient services that require notification/authorization based on payer specific guidelines.
  3. Responsible for clinical part of audit to determine if all charges have been captured appropriately.
  4. Maintains a thorough understanding of the plan's provider contracts, authorization requirements and Interqual Criteria
  5. Provides ongoing follow-up and re-evaluation of clinical departments/areas as requested or needed for authorization review
  6. Enters authorization information into EPIC and maintains authorization data.

Minimum Qualifications:

  • Nurse in good standing, currently licensed in the State of Texas without stipulations in practice as a Licensed Vocational Nurse
  • Minimum 6 months of utilization review, coding/billing, or authorization/case management experience (required).
  • Familiarity with hospital coding and billing processes (preferred).
  • Knowledge of Interqual/Milliman guidelines (preferred).
  • EPIC EMR experience (preferred).
  • Experience in various clinical areas (preferred).

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