Payor Relations Specialist - Inpatient Rehab

Job Summary

Northshore Rehabilitation Hospital, a joint venture with Select Medical & Ochsner Medical Center, is seeking a Payor Relations Specialist / Prior Authorization Specialist, with a requirement for a Registered Nurse (RN) or Licensed Practical Nurse (LPN).

Job Responsibilities

• Manages pre-certification and prior authorization of referrals for admission to the Acute Inpatient Rehabilitation Hospital.
• Follows the Select Workflow Process for initiating and completing patient authorizations.
• Takes full responsibility for following the workflow process and ensuring each referral adheres to the process from initial referral to final disposition, acceptance or denial.
• Submits pre-admission assessments completed by clinical liaisons to insurance companies.
• Ensures documentation meets standards and expectations by working and mentoring the team as needed.
• Obtains timely authorization for all patients requiring pre-certification and is accountable for conversion percentage and results.
• Fulfills responsibilities to minimize financial risk by following policies governing commercial pre-certification and authorization.
• Develops and maintains relationships to increase and stabilize conversion rates and generate referrals both locally and regionally.
• Maintains profiles on each payer to include case managers and medical directors, P2P and appeal information.
• Identifies and utilizes payor communication preferences to maximize results.
• Encourages and models teamwork, communication, and collaboration with other departments, including the transition of patients into critical illness recovery hospitals or acute inpatient rehabilitation hospitals.
• Serves as a resource to the Business Development Team, educating them on payor preferences to promote exceptional customer service and efficient processes.
• Maintains and develops relationships with customers, including conducting surveys for satisfaction with Select Medical's work and participating in off-site meetings with customers.
• Evaluates non-medicare benefits as verified by the Central Business Office or Rehab Admissions Coordinator, reviews benefits with Admissions Coordinator for possible risk, and applies/completes written guidelines as necessary to reduce or manage risk.
• Answers phones with appropriate behavior and ensures back-up when not available or out of the office.
• Works closely with Admissions Coordinator to apply correct accommodation codes per contract and billing/reimbursement requirements.
• Tracks approval and denials through TOC.
• Ensures outstanding customer service for all customers.

Minimum Qualifications

• Licensure as a Registered Nurse or LVN/LPN is required.
• Two years of direct experience in third-party reimbursement is required.

Preferred Experience

• Previous experience within a physical rehabilitation setting.
• Experience working with Excel and databases.