In a career as an Outpatient Diag Srvcs RN, you join a team that is changing the lives of youth and families every day.Under the direction of the Nurse Manager, Patient Access, performs specialized administrative duties pertaining to order entry and the scheduling and coordination of outpatient/non-sedated patient services, utilizing knowledge of both nursing and administrative practices. Acts as the primary point of contact for coordinating single or multiple service needs, scheduling, collecting pertinent clinical and demographic data, validating benefits and obtaining necessary prior authorization, or making referrals to Financial Counselor for outpatient services which include but are not limited to: infusions, Outpatient GI Clean-outs, genetic testing, sleep study, CT/MRI, EEG and other services as identified then creating a patient plan the outlines scheduled services, date of service, scheduled time and where to present for care to be rendered. Provides excellent communication to providers, ancillary service team members, Patient Access and patients to ensure a successful patient experience and service outcome.
Schedule: Monday-Friday, 8:00a.m.-4:30p.m. No Holidays or weekends.
Accepts orders from internal and external provider sources via electronic, fax or verbal routes validating medical necessity and indication for testing as well as priority for scheduling.
Coordinates with necessary Ancillary departments or Inpatient Medical Unit to determine availability of necessary resources taking into consideration additional testing or services ordered and to be received on the same date of service to make the visit as efficient and effective as possible.
Enters all non-electronic orders into necessary clinical based system following necessary documentation requirements.
Works to obtain and review pertinent clinical and demographic documentation to support medical necessity for ordered services which includes forwarding to HIM department for entry into the patient's legal medical record for future reference if needed.
Validates insurance eligibility and benefits identifying and fulfilling prior authorization requirements as identified in advance of services being rendered, or marking as urgent for immediate care needs to not impede urgent or emergent care.
Creates patient plan outlining ordered services, scheduled date, time services are scheduled to take place and location for patient to present for check-in.
Provides timely communication to ordering providers as well as patient/guardian of scheduled services providing education to the patient/guardian of what to expect as well as providing cost estimation upon request or as potential non-covered services are identified.
Communicates patient plan with anticipated services to Patient Access for reference at the time patient arrives for check-in along with indication for Consent to Treat, Advanced Beneficiary Notice, Non-covered Service Notification, request for updated legal guardianship documentation or need to collect payment prior to service, etc. as identified during care coordination and scheduling process.
Provides assistance in coordinating post-discharge follow-up clinic and/or other outpatient ancillary testing or diagnostic needs prior to patient discharge from medical unit.
Ensures proper consent, authorization and coverage determination which includes prior authorization is in place prior to any genetic testing services being rendered which includes identification of newly developed or requested testing and working to develop hard stops prior to draw to ensure services are covered and patients are educated to potential liabilities and outcome of testing.
Establishes and maintains a log of orders received, approved or denied by insurance payers.
Educates families regarding insurance benefits which include providing out of pocket liability projections, potential non-covered services as well as advising of coordination of benefit requirements or the need to add a newborn to their insurance policy within a specific timeframe.
Provides overflow assistance to Utilization Review Team as necessary working to provide notice of admission to Medical Unit for Observation and Inpatient stays as identified utilizing Interqual or other payer specific guidelines as determined by the payer.
Provides overflow assistance to Surgery Pre-Admissions team as necessary when coordination of surgical and non-surgical services is required and/or as needed to manage surgical service demands.
Offers assistance to clinical services in working to obtain prior authorizations for clinic based services such as injections, Rx medication, clinic based procedures and other services as identified when needed.
Other Duties: This job description incorporates the essential functions and duties required for this position. However, other duties may be required and assigned at times and as determined by the Director in order to meet the needs of the organization.
Knowledge, Skills and Abilities Required
Knowledge of The Joint Commission standards and other regulatory/accreditory agencies
Ability to apply knowledge of all ages and developmental levels to care provided.
Ability to demonstrate clinical competence in providing patient and family education on upcoming surgical procedure(s).
Ability to make assessments and problem solve independently.
Ability to maintain licensure and professional growth by participation in professional conferences.
Ability to work in a fast paced environment with frequent interruptions, responding quickly and calmly to urgent and potentially stressful situations.
Ability to utilize a variety of computer programs to manage work; familiarity with Windows and Office programs such as Word and Excel.
Knowledge of compliance issues and their importance and consequence.
Ability to communicate effectively and concisely, both orally and in writing, with providers, patients, families and all levels of management and staff to enhance care and provide best practice.
Ability to serve as a positive role model, supporting the mission of the organization and maintaining a high level of integrity, confidentiality and professionalism.
Provides patient care and education according to the patient population served.
A registered nurse who is a graduate of an accredited school with current state or multi-state licensure, required
Experience in surgery scheduling and/or admissions generally obtained by working in a perioperative clinical setting with knowledge of surgical procedures and anesthesia types, required,
Minimum of two years' experience in an acute hospital setting with pediatric experience, preferred
Experience working in an operating room, preferred,
Must have good communication, assessment, and organizational skills,
Must have good PC skills including experience with Microsoft Outlook, Word, and Excel
Must have good public relation skills and be detail oriented
Must be BLS certified.
About Boys Town:
Boys Town has been changing the way America cares for children and families since 1917. With over a century of service, our employees have helped us grow from a small boardinghouse in downtown Omaha, Nebraska, into one of the largest national child and family care organizations in the country. With the addition of Boys Town National Research Hospital in 1977, our services branched out into the health care and research fields, offering even more career opportunities to those looking to make a real difference.
Our employees are our #1 supporters when it comes to achieving Boys Town's mission, which is why we are proud of their commitment to making the world a better place for children, families, patients, and communities. Unique perks to Boys Town employees and their families include free visits to Boys Town physicians and free prescriptions under the Boys Town Medical Plan, tuition assistance, parenting resources from our experts and professional development opportunities within the organization, just to name a few. Working at Boys Town is more than just a job, it is a way of life.
This advertisement describes the general nature of work to be performed and does not include an exhaustive list of all duties, skills, or abilities required. Boys Town is an equal employment opportunity employer and participates in the E-Verify program. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. To request a disability-related accommodation in the application process, contact us at 1-877-639-6003.
Since the opening of Boys Town National Research Hospital in 1977, the hospital has been internationally recognized as a leader in clinical and research programs focusing on childhood deafness, visual impairment and related communication disorders. We have developed national medical programs that are now instituted in hospitals and clinics across the country.
Today, the hospital offers a broad range of clinical services, including ear, nose and throat services at the Boys Town Ear, Nose and Throat Institute, general pediatric care with Boys Town Pediatrics, and orthopaedic, internal medicine, pediatric gastroenterology, allergy, asthma, pediatric pulmonology, behavioral health, audiological and ophthalmologic care.
The hospital has expanded to offer surgical and clinical services at two Omaha locations: 555 North 30th Street in Omaha and 14000 Hospital Road on the campus of Boys Town, Nebraska.
Boys Town National Research Hospital has assembled national leaders in research who are making important contributions in the areas of genetics, hearing, language, vision and speech disorders. Applying these findings with new technologies, distance learning and the exploration of ne...w research frontiers, the opportunities for new medical diagnoses, evaluation and treatment discoveries are endless.
Accredited by The Joint Commission, Boys Town National Research Hospital is dedicated to providing leading edge clinical care, pioneering translational research and improving the lives of children and their families through applied technology and educational outreach programs. The hospital annually serves more than 40,000 children and families from across the United States.