Revenue Cycle Precertification Nurse (LPN)

About the role

The Revenue Cycle Precertification Nurse ensures financial security for scheduled inpatient and outpatient accounts by obtaining prior authorizations and verifying medical necessity. This position works closely with physicians, case management, and revenue cycle staff to support accurate billing and compliance.

Key responsibilities

• Secure clinical documentation and perform pre‑service medical necessity reviews to obtain prior authorizations for ordered services.
• Coordinate with physicians and staff to confirm appropriate level of care and essential documentation.
• Collaborate with Case Management on level‑of‑care decisions for direct admits and inpatient stays.
• Maintain regulatory compliance and support day‑to‑day department operations.

Required profile

• Licensed Practical Nurse (LPN) diploma and current LPN license in the state of practice.
• Minimum 3 years of hospital‑based patient care experience; ambulatory experience preferred.
• Ability to work under general supervision while following moderately complex procedures and guidelines.

Required skills

• Proficiency with computer applications, software, and web‑based tools.
• Working knowledge of CPT and ICD‑10 coding terminology.
• Understanding of medical necessity criteria, pre‑certification guidelines, and insurance billing processes.