Payor Relations Specialist - Inpatient Rehab

Baylor Scott & White Institute for Rehabilitation - Dallas Downtown Hospital • Dallas, TX

3d • Onsite

About The Position

The Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute Inpatient Rehabilitation Hospital. This role follows the Select Workflow Process for initiating and completing patient authorizations, ensuring each referral adheres to the process from initial referral to final disposition. The specialist is responsible for submitting pre-admission assessments to insurance companies, ensuring documentation meets standards, and obtaining timely authorization for all patients requiring pre-certification. This position is crucial for minimizing financial risk by ensuring compliance with commercial pre-certification and authorization policies. The role also involves developing and maintaining relationships with payers, including case managers and medical directors, and serving as a resource to the Business Development Team by educating them on payor preferences. Additionally, the specialist evaluates non-Medicare benefits, reviews benefits with the Admissions Coordinator for risk assessment, and ensures outstanding customer service for all customers.

Requirements

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

Nice To Haves

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

Responsibilities

• Manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute Inpatient Rehabilitation Hospital.
• Follows the Select Workflow Process for initiating and completing patient authorizations.
• Ensures each referral follows the process, from taking the initial referral until final disposition, acceptance or denial.
• Submits the pre-admission assessments completed by clinical liaisons to the insurance company.
• Ensures documentation meets standards and expectations.
• Obtains timely authorization of all patients requiring pre-certification.
• 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 profiles on each payer to include case managers and medical directors, P2P and appeal info.
• Identifies by payor communication preference and utilizes to maximize results.
• Encourages and models teamwork, communication and collaboration with other departments.
• Serves as a resource to the Business Development Team educating them on payor preference to promote exceptional customer service and efficient processes.
• Maintains and further develops relationships 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 phone with appropriate behavior and ensures back-up when not available or out of the office.
• Works closely with Admissions Coordinator to apply correct accommodation code per contract as well as billing/reimbursement requirements.
• Tracks approval and denials through TOC.
• Ensure outstanding customer service for all customers.
• Performs other duties as requested.

Benefits

• Extensive and thorough orientation program
• Generous PTO and Paid Sick Time for full-time team members
• Comprehensive medical/RX, health, vision, employee assistance program (EAP) and dental plan offerings for full-time team members
• Company-matching 401(k) retirement plan
• Life and disability protection for full-time team members

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed