LVN Preauthorization Nurse Auditor- Galleria Area
Houston Galleria, TX
Job duties include:
-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
-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 plan's provider contracts and authorizations requirements
-Performs prior authorization and retrospective clinical review
-licensed LVN in the state of Texas
-Minimum 6 months of utilization review, coding/billing, or authorization/case management experience required.
-Familiarity with hospital coding and billing processes preferred.
-Typing requirement 25 wpm