JOB PURPOSE OR MISSION: Provide Interventional Pain Management services to all patients at a level consistent with Baton Rouge Rehabilitation Hospital (BRRH) mission, vision, and values. Responsible for pre-assessment evaluation for each scheduled procedure to ensure appropriate clinical level of care, ensuring appropriate documentation demonstrating medical necessity and complying with organizational standards is submitted by physician prior to scheduled procedure.
JOB FUNCTIONS
ESSENTIAL JOB FUNCTIONS include, but are not limited to:
1. Coordinates utilization of clinical and financial resources
PERFORMANCE STANDARDS:
- Reviews patient medical history according to procedure/surgery prior to booking surgery.
- Ensures physician documentation is identified, accurate, and complete according to the regulations/policies of individual payers for procedure/surgery scheduled for each assigned patient.
- Communicates with physician office for each patient to ensure accurate documentation to ensure that proper documentation is complete prior to scheduled admission.
- Identifies accurate payer information for each assigned patient.
- Communicates and collaborates with admission/precertification department to ensure appropriate payer precertification is completed.
- Performs admission review on all assigned patients within one business day of admission for appropriateness of admission based on medical necessity.
- Refers appropriate cases to physician advisor or designee, communicating via email and/or telephonically.
- Communicates with physician as needed to ensure the correct procedure type based on physician clinic note/History & Physical. Able to delegate this task to others as needed
- Contacts physician and/or Manager for additional information regarding cases not meeting medical necessity criteria for admission procedure.
- Identifies and refers problem cases to appropriate Manager and/or supervisor.
- Maximizes reimbursement to BRRH by:
- Helping to ensure that physician documentation supports current clinical level of care.
- Communicating and collaborating with Manager or Admissions Coordinator to assist with appropriate interventions to avoid denial of payment.
- Assisting in denials/appeals processes.
- Identifies and communicates to the Manager/Department Director opportunities for more efficient resources utilization.
- Communicates and collaborates with Admissions Coordinator for:
- Cases that are not meeting medical necessity criteria for admission for procedure.
- Cases that are requiring peer to peer conferences.
- Cases that have been issued denials and/or rejections.
- Collaborates with the Manager in the development and implementation of the procedural plan.
- Documents specific patient information received regarding patient’s history.
2. Coordinates patient assessment through collection of patient’s health data.
- Coordinates with admissions office staff, clinical staff and physicians in reference to scheduling procedures daily and patient’s paperwork for required medical necessity
- Completes and reviews patient chart information related to the patient’s history, procedure and physician preferences
- Ensures completion of all preop calls are completed with all necessary information collected and all necessary information give to the patient related to procedure preparation.
- Communicates ongoing throughout the day with the admission office on all identified issues
- Delegates to staff any necessary preprocedural work to be completed
- Ensures accuracy of patient packet/procedure listed/paperwork for chart.
- Maintains copies of paperwork and utilizes the excel spreadsheet for keeping accurate/updated case schedules and updated case volume logs
- Contacts and requests information as needed from physician offices concerning preprocedural preparation.
- Involves the patient, significant others and health care providers as appropriate.
- Identifies and coordinates the need for further assessment by discipline.
3. Participates in quality improvement activities.
PERFORMANCE STANDARDS:
- Reports sentinel events and quality of care issues to the Manager/Department Director.
- Collects and tracks data (denials, avoidable days, etc.) as determined by Supervisor and/or Director.
- Participates in performance improvement activities as needed.
4. Performs all other duties as assigned.Minimum 2 years nursing experience preferred.
EDUCATIONAL REQUIREMENTS
Current Louisiana LPN licensure
Current BLS Healthcare Provider
SPECIAL SKILL, LICENSE AND KNOWLEDGE REQUIREMENTS
Knowledge/skill in Microsoft Office products (Word, Excel), Microsoft Edge and Outlook
Ability to organize and prioritize work for optimal results
Excellent analytical and problem-solving skills
Current Louisiana LPN License
Knowledge of ICD-9/10 coding preferred
Demonstrate competency in patient assessment, venipuncture, phlebotomy and ASA classification
