Payor Relations Specialist

About the role

This position provides remote support to Select Specialty Hospitals in Charleston, Morgantown, Wheeling, and Weirton. As the Payor Relations Specialist, you will manage the pre-certification and prior authorization of referrals scheduled for admission to our hospital, which cares for chronically and critically ill or post-ICU patients requiring extended hospital care.

Responsibilities

• Communication with Payors
  • Initiates and completes patient authorizations.
  • Obtains timely authorization of all patients requiring pre-certification and is accountable for conversion percentage and results.
  • Ensures all policies governing commercial pre-certification and authorization are followed to minimize financial risk.
  • Develops relationships that increase and stabilize conversion, as well as generates referrals both locally and regionally.
  • Maintains relationship profile by payor for payor case managers and medical directors.
• Collaborate with Business Development/Case Management
  • Encourages a smooth and effective hand-off of patients to Case Management to ensure continuity in patient care plan.
  • Serves as a member of the Business Development Team by educating the team on payor preference to avoid backtracking and rework.
  • Maintains and further develops relationships with customers, which may include but is not limited to, surveying for satisfaction with the work of Select Medical and off-site meetings with the customer.
• Financial/Risk Responsibilities
  • Evaluates Commercial benefits as verified by the Central Business Office.
  • Reviews benefits with Admissions Coordinator for possible risk and applies/completes written guidelines as necessary to reduce or manage risk.
  • Completes billing and reimbursement and shares it with the Admissions Coordinator and Case Management team.

Requirements

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

Preferred Experience

• Experience working with Excel and databases.