LPN PRE-AUTH COORDINATOR

Location
Norfolk, VA
Posted
Apr 05, 2018
Closes
Apr 19, 2018
Function
Nurse
Industry
Healthcare
Hours
Full Time
Job Description:
Optima Health Community Care is seeking a Licensed Practical Nurse (LPN) to join our Government Authorizations team in Norfolk, VA. This is a full-time benefited position.

Responsible for review of clinical information received from Physicians and other Clinical providers ensuring clinical data is substantial enough to authorize services. Analyzes clinical information to ensure the services requested are authorized according to clinical protocols. Responsible for validation of member benefits for the services requested. Validates accuracy of insurance enrollment information in the system prior to authorizing services. Requires knowledge of managed care contracting, clinical protocols and clinical review requirements. Requires knowledge of regulatory and compliance requirements for government payers, self funded and commercial payers. Ensures appropriate and accurate information is entered into claims system for processing of payment.

Education Level
Trade School Graduate

Experience
Required: Related - 3 years

Preferred: None, unless noted in the “Other” section below

License
None, unless noted in the “Other” section below

Skills
None, unless noted in the “Other” section below

Other
Related clinical experience as a Medical Assistant or LPN experience in a physician office, acute care, managed care or clinic setting. Active license required as applicable.

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