Prior Authorization Specialist / Payor Relations Specialist ( RN , LPN )

Select Specialty Hospital-Knoxville • Knoxville, TN

97d

About The Position

At Select Specialty/Regency Hospitals, a division of Select Medical, we care for chronically and critically ill or post-ICU patients who require extended hospital care. Select Medical employs over 48,000 people across the country and provides quality care to approximately 70,000 patients each and every day across our four divisions. Our mission is to provide an exceptional patient care experience that promotes healing and recovery in a compassionate environment. Each employee plays a vital role in doing that by living our cultural behaviors - celebrating success, owning the future, being patient-centered, creating change, thinking first and building trust.

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 our 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 profile 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.
• Educate the Business Development Team on payor preference to avoid backtracking and rework.
• Maintain and further develop relationships with customers, including surveying for satisfaction and off-site meetings.
• Evaluate Commercial benefits as verified by the Central Business Office.
• Review benefits with Admissions Coordinator for possible risk and apply/completes 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 to ensure a smooth transition into our setting.
• Generous PTO to maintain a healthy work-life balance.
• Comprehensive medical/RX, health, vision, and dental plan offerings.
• Company-matching 401(k) retirement plan, as well as life and disability protection.
• Company paid parking.

What This Job Offers

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