Payor Relations Specialist

About the role

As a Payor Relations Specialist at Riverside Rehabilitation Hospital in partnership with Select Medical, you will champion the Select Medical Way by prioritizing patient care, improving community quality of life, and fostering innovation while delivering high-quality service and ethical decision-making.

Responsibilities

• Manage pre-certification and prior authorization for patient referrals scheduled for admission.
• Initiate and complete patient authorizations, ensuring timely approvals and accountability for conversion rates.
• Follow commercial pre-certification and authorization policies to minimize financial risk.
• Develop and maintain relationships with payors to increase and stabilize conversion rates and generate referrals locally and regionally.
• Maintain payor profiles, including case manager and medical director contacts.
• Collaborate with Business Development and Case Management to ensure smooth patient hand-offs and continuity of care.
• Educate the Business Development team on payor preferences to reduce rework and backtracking.
• Conduct customer satisfaction surveys and participate in off-site meetings with payor representatives.
• Evaluate commercial benefits as verified by the Central Business Office and review them with the Admissions Coordinator to identify and manage financial risk.
• Complete billing and reimbursement processes and share relevant information with the Admissions Coordinator and Case Management team.

Requirements

• At least two (2) years of direct experience in third-party reimbursement.
• Current licensure as a Registered Nurse (RN) or Licensed Practical Nurse (LPN).

Preferred Qualifications

• Experience working with Excel and databases.