Payor Relations Specialist

Riverside Rehabilitation Hospital • Yorktown, VA

2d • Onsite

About The Position

Riverside Rehabilitation Hospital, in partnership with Select Medical, is seeking a Payor Relations Specialist/Prior Authorization Specialist. This is a full-time position, Monday through Friday, 8 am to 5 pm. Select Medical is a leading provider of long-term acute care services and a major healthcare provider in the U.S. with a network of over 47,000 employees, 120 inpatient hospitals, 1600 outpatient therapy centers, and 500 urgent care facilities. Our employees are guided by core values and cultural behaviors that drive exceptional patient and employee experiences.

Requirements

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

Nice To Haves

• Experience working with Excel and databases

Responsibilities

• Manage the pre-certification and prior authorization of referrals scheduled for admission to the hospital.
• Initiate and complete patient authorizations.
• Obtain timely authorization of all patients requiring pre-certification and be accountable for conversion percentage and results.
• Ensure all policies governing commercial pre-certification and authorization are followed to minimize financial risk.
• Develop relationships that increase and stabilize conversion, as well as, generate referrals both locally and regionally.
• Maintain relationship profiles by payor for payor case managers and medical directors.
• Encourage a smooth and effective hand-off of patients to Case Management to ensure continuity in patient care plan.
• Serve as a member of the Business Development Team by educating the team on payor preference to avoid backtracking and rework.
• Maintain and further develop relationships with customers, which may include surveying for satisfaction with the work of Select Medical and off-site meetings with the customer.
• Evaluate Commercial benefits as verified by the Central Business Office.
• Review benefits with the Admissions Coordinator for possible risk and apply/complete written guidelines as necessary to reduce or manage risk.
• Complete billing and reimbursement and share it with the Admissions Coordinator and Case Management team.

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