Revenue Cycle Precertification Nurse – LPN

Ochsner Health

. Secure clinical documentation and perform pre-service medical necessity reviews to obtain prior authorizations .

Posted 11/6/2026full-timeRemote • Louisiana • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical documentation, medical necessity reviews, and prior authorization processes while ensuring compliance with regulatory requirements. Proficient in patient care delivery and effective communication within a healthcare setting.

Highest-signal resume keywords

Licensed Practical Nurse (LPN)Medical Necessity Criteria ApplicationCPT and ICD-10 Terminology KnowledgeEffective Communication SkillsCustomer Service Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical DocumentationPrior AuthorizationPatient Care DeliveryInsurance Billing ProcessesMedical Necessity ReviewsCritical ThinkingAnalytical SkillsAttention to DetailTime ManagementOrganizational Skills

Soft Skills

Interpersonal SkillsCollaborative SkillsDecision-Making SkillsAbility to Handle High-Pressure SituationsAbility to Work with Minimal Supervision

Tools & Technologies

Web-Based ApplicationsComputer ProficiencySoftware Proficiency

Certifications & Qualifications

Current LPN License

Industry Keywords

Regulatory RequirementsAccreditation StandardsComplianceMedicare GuidelinesHMO and PPO Contracts

About the role

Key responsibilities & impact

Secure clinical documentation and perform pre-service medical necessity reviews to obtain prior authorizations
Ensure the financial security of scheduled inpatient and outpatient accounts, excluding ED accounts, by obtaining or initiating prior authorization based on payer requirements
Coordinate with physicians and staff regarding the appropriate level of care and clinical documentation supporting medical necessity
Collaborate with Case Management to establish the level of care for direct admissions and inpatient stays
Serve as a resource for Revenue Cycle staff within Pre-Service
Perform duties under general supervision and according to moderately complex procedures and guidelines
Maintain professional and technical knowledge and certifications
Ensure all departmental regulatory requirements are met
Assist with day-to-day department operations
Support company business-service goals and core values
Remain compliant with applicable laws, regulations, accreditation standards, and regulatory requirements
Report known or suspected unethical conduct and patient, employee safety, privacy, or compliance concerns
Perform other duties as assigned

Requirements

What you’ll need

Licensed Practical Nurse (LPN) diploma
3 years of hospital based experience in the delivery of patient care
Current LPN license in the state of practice
Ambulatory experience preferred
Proficiency in using computers, software, and web-based applications
Effective verbal and written communication skills
Ability to present information clearly and professionally
Excellent customer service skills
Ability to gather and disseminate information with diverse people in person or over the phone
Excellent interpersonal and collaborative skills
Ability to handle high-pressure, difficult situations
Good organizational and time management skills
Ability to work with minimal supervision
Excellent decision-making, critical-thinking, analytical, and attention-to-detail skills
Proficiency in applying medical necessity criteria, standards of practice, and researching pre-certification guidelines
Ability to prioritize and manage multiple tasks efficiently and with quality
Working knowledge of CPT and ICD-10 terminology, Medicare guidelines, HMO and PPO contracts, and insurance billing processes
Ability to remain knowledgeable about applicable federal, state, and local laws, accreditation standards, and regulatory requirements
Ability to comply with the employer’s Compliance & Privacy Program and Standards of Conduct

Benefits

Comp & perks

Full-time employment
Equal opportunity employment
Reasonable accommodations for individuals with disabilities
Accessibility support and application accommodations