Payor Relations Specialist

Select Medical • Yorktown, VA

2d • Onsite

About The Position

Riverside Rehabilitation Hospital, in partnership with Select Medical, is seeking a Payor Relations Specialist, also known as a Prior Authorization Specialist. This is a full-time position, Monday through Friday, from 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 across various facilities. We are looking for professionals who embody our core values and cultural behaviors, focusing on patient-first care, community improvement, innovation, and ethical practices. As a Payor Relations Specialist, you will be responsible for managing the pre-certification and prior authorization process for patients admitted to our hospital.

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

• Initiates and completes patient authorizations.
• Obtains timely authorization for all patients requiring pre-certification, ensuring accountability for conversion percentage and results.
• Ensures adherence to all policies governing commercial pre-certification and authorization to minimize financial risk.
• Develops relationships that increase and stabilize conversion, and generates referrals locally and regionally.
• Maintains relationship profiles by payor for payor case managers and medical directors.
• Collaborates with Business Development/Case Management to ensure a smooth and effective hand-off of patients, maintaining continuity in patient care plans.
• Serves as a member of the Business Development Team, educating the team on payor preferences to avoid backtracking and rework.
• Maintains and further develops relationships with customers, including surveying for satisfaction and conducting off-site meetings.
• Evaluates Commercial benefits as verified by the Central Business Office.
• Reviews benefits with the Admissions Coordinator to identify potential risks and applies written guidelines as necessary to reduce or manage risk.
• Completes billing and reimbursement information and shares 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