Precertification Nurse (Mulitiple Positions)

Want to use your Nursing experience for something other than patient care? Want to help those that truly need assistance by obtaining needed benefits? Want to work a set schedule every week and have an office job? Would you like to work for a company that's a LEADER in its industry? How about a company that really does make a difference by helping people?

Chamberlin Edmonds is an eligibility speciaist company and works as an augmentation to existing hospital staff to assist uninsured patients through the difficult processes of applying for medical assistance. Chamberlin Edmonds relieves patients and hospital staff from the confusion and frustration of the application process. Our unique expertise enables us to obtain short-term funding solutions and, whenever appropriate, to secure long-term Medicare conversions for patients.

We are currently seeking RNs and LPNs to review medical records and write pre-certifications for  Florida hospital admissions. The Pre-Cert Nurse will be responsible for abstracting information from medical records and applying the information to precertification forms, which are then submitted to Medicaid agencies for approval for payment. The payments are then applied to outstanding hospital patient bills.

Duties Include:

• Documenting all diagnostic procedures using ICD-9 and CPT codes
• Reviewing completed precertifications for accuracy prior to submission
• Following up with our Medicaid Eligibility Specialists to obtain necessary medical records
• Identifying and clarifying inpatient versus outpatient stays, discharge dates and times as well as other vital information
• Writing precertification appeals in a timely manner and notifying appropriate parties of expiration dates
• Generating weekly reports to identify outstanding medical records needed
• Following up with our medical records staff to obtain and notate as medical records are requested and received
• Obtaining precertification numbers via automated system and performing appropriate documentation in computer system
• Completing necessary lab result forms in a timely mannner for submission

• Licensed RN/LPN with strong understanding of medical terminology
• Minimum of 3 years experience in a medical setting
• Knowledgeable of Florida Medicaid guidelines/services
• Must have experience with InterQual Criteria or Milliman Care Guidelines
• Proficient computer skills, including word processing and data entry, (MS Office, Excel preferred)
• Legible handwriting
• Previous experience with ICD-9 and CPT coding is highly preferred

• Medical, Dental and Vision Insurances
• 401(k) with Employer match
• Competitive Salaries
• Paid Time Off
• Advancement Opportunities
• Incentive Compensation

• Company Training
• Term Life Insurance
• Short and Long-term disability insurances
• Long Term Care insurance
• Flexible Spending Accounts (FSA)