KPC Promise Heatlhcare: The Pre-Authorization Nurse is
responsible for executing the registration functions such as
insurance identification, verification and authorization in all
areas of pre-admission, inpatient, outpatient services and
outpatient surgery, review of admission criteria and admission of
patients with medical needs. Using knowledge of LTACH criteria,
DRGs, PPS reimbursement, utilization management and HIM coding,
this position will maximize clinical data collection in order to
support the most appropriate admission MSDRG. Accomplishes the
daily operation of all pre-admission activities. This individual is
responsible for reviewing documentation for appropriateness of
admissions, coordination of all admissions with other departments
through the collection, assembly and distribution of appropriate
1. Registered Nurse or Licensed Practical Nurse, Current,
unencumbered Florida License.
2. Two to four years of experience in hospital registration
3. Working knowledge of the Hospital Admitting Department and/or
Business Office procedures.
4. Strong knowledge of Medical Insurance Processes.
5. Must be able to read, write, and speak English, as well as
possess good written and oral communication skills
PHYSICAL AND MENTAL REQUIREMENTS:
Physical: Walking – up to 25% Standing – up to 15% Kneeling – up
Sitting – up to 30% Pushing – up to 5% Bending – up to 5%
Squatting – up to 5% Pulling – up to 5% Reaching - up to 5%
Lifting - up to 25 lbs. Wrist/Finger Movements – up to 90%
Mental: Stress Level: Moderate to high
EXPOSURE RISK: Category III - Jobs in which required tasks
involve no greater exposure to blood, body fluids or tissues than
would be encountered by a visitor. The normal work routine involves
no exposure to blood, body fluids, or tissues.
EQUIPMENT, TOOLS, MATERIALS, MACHINES USED: Computer, telephone,
facsimile machine, copier, scanner, printer, calculator and other
standard office equipment.
RATING DEFINITION: (5) Far exceeds expectations (4) Exceeds