Payor Relations Specialist - Inpatient Rehab

Northshore Rehabilitation Hospital • Lacombe, LA

13d • Onsite

About The Position

Northshore Rehabilitation Hospital, a joint venture with Select Medical & Ochsner Medical Center in Lacombe, LA, is seeking a Payor Relations Specialist / Prior Authorization Specialist. This is a full-time position, Monday through Friday, from 8:00 AM to 5:00 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 and numerous facilities. Our employees are driven by core values and cultural behaviors focused on delivering exceptional patient and employee experiences.

Requirements

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

Nice To Haves

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

Responsibilities

• Manages the pre-certification and prior authorization of referrals for admission to the Acute Inpatient Rehabilitation Hospital using discretion and independent judgment.
• Follows the Select Workflow Process for initiating and completing patient authorizations, taking full responsibility from referral to final disposition.
• Submits pre-admission assessments to insurance companies as appropriate.
• Ensures documentation meets standards and expectations, mentoring the team as needed.
• Obtains timely authorization for 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 to increase and stabilize conversion and generate referrals locally and regionally.
• Identifies relationship opportunities for self and others within Select Medical to grow relationships and impact results.
• Maintains profiles on each payer, including case managers, medical directors, P2P, and appeal information.
• Identifies and utilizes payer communication preferences to maximize results.
• Encourages and models teamwork, communication, and collaboration with other departments for patient transitions.
• 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 surveying for satisfaction and conducting off-site meetings.
• 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 written guidelines to manage risk.
• Answers phone with appropriate behavior and ensures back-up coverage when unavailable.
• Works closely with Admissions Coordinator to apply correct accommodation codes per contract and billing/reimbursement requirements.
• Tracks approvals and denials through TOC.
• Ensures 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