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SERVICE ACCESS NURSE

Job Title: SERVICE ACCESS NURSE
Job Code: 5506
FLSA: E
Job Level: F1
Revised Date: 07/01/2014
Supervisory Responsibility: Yes

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General Description of the Job Class

Manage patient intake process (including patient triage and admissions) for non-critical transfer patients into Duke University Health System from referring hospitals, clinics, and physicians offices, ensuring appropriate level of care and financial screening.

Duties and Responsibilities of this Level

Evaluate appropriate level of patient care, utilizing expert level clinical decision making to determine severity of illness for all elective, urgent and emergent admissions. Requires expert level analysis of patient clinical information and formulation of an accurate assessment of the patient and his/her condition.

Coordinate with patient, physicians, nursing and/or clinical staff when requirements of admission are not met/authorized, requiring facilitation of alternative care arrangements, physician/administrative override, or delay in service.

Responsible for collecting accurate and viable patient insurance information, and escalating all self-pay patients through the appropriate financial screening process (i.e. POMC, Medicaid, Charity Care, patient liability).

Coordinate with physician, nursing and/or clinical staff in determining that the following have all been secured: (1) referral authorizations, (2) prior approval of specific treatments and surgical procedures, and (3) second surgical opinions of specific treatment/surgical procedures.

Analyze clinical and financial information received on proposed admissions for coding accuracy, difficulty in obtaining authorization, and potential for financial issues .

Initiate and facilitate pre-admission and pre-certification authorizations, requiring the detailed evaluation of clinical documentation.

Responsible for ensuring all scheduled surgical cases are reconciled with the appropriate billing system.

Ensure inpatient vs. outpatient scheduling criteria are met in accordance with published payer CPT lists.

Enter detailed documentation of actions and outcomes in applicable billing system.

Health System resource for coding of ICD-9 diagnoses/procedures, CPT-4 procedures, DRG, & APC assignment.

Trainer and preceptor of Pre-Registration staff in ensuring their clinical knowledge needed to fulfill their position responsibilities.

Provide quality assurance reviews of Pre-Registration staff work, ensuring internal controls are met.

Conduct denial appeal follow-up, through analysis of clinical documentation to support level of care provided and secure reimbursement.

Clinical and health care financial resource to PRMO and broader health system membership.

Expert in medical terminology and clinical data interpretation.

Liaison to all hospital and PDC departments and their staff members, including physicians, clinical nurses, Patient Resource Managers, clinic staff and bed control.

Liaison to Patient Service Representatives, Billers, Collectors, internal and external Case Managers/Patient Resource Managers, Social Workers, and Discharge Planners.

Perform other related duties incidental to the work described herein.

Required Qualifications at this Level

Education

BSN Required

Experience

3 years of nursing experience

Degrees, Licensure, and/or Certification

R.N. licensure and North Carolina State Licensure required.

Knowledge, Skills, and Abilities

Excellent communication skills; written and verbal.

Excellent customer service skills, including phone etiquette.

Ability to establish good working relationships with associate departments.

Working knowledge of ICD-9/CPT-4 coding.

Distinguishing Characteristics of this Level


The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.


Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.


Essential Physical Job Functions

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.