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St. Luke’s University Health Network
Quakertown, Pennsylvania
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Duke University Health System
Durham, North Carolina
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PIH Health
La Mirada, California
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LVN Pre/Authoriz Nurse Auditor
JOB SUMMARY: 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'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 clinical part of audit to determine if all charges have been captured appropriately. Maintains a thorough understanding of the plan's provider contracts, authorization requirements and Interqual Criteria Provides ongoing follow-up and re-evaluation of cli
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