Prior Authorization Specialist - Weekend Only

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

22d•Remote

About The Position

Baylor Scott & White Institute for Rehabilitation, a joint venture with Select Medical & Baylor Scott & White, is seeking a Prior Authorization Specialist (RN or LPN) for a part-time weekend position. This role involves working every Saturday and Sunday, 8 hours each day. The position is primarily work-from-home, but candidates must live within driving distance of Austin, TX, Temple, TX, and the DFW area.

Requirements

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

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 scheduled 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 initial referral to final disposition.
Submits pre-admission assessments to the insurance company as appropriate.
Ensures documentation meets standards and expectations, working and mentoring the team as needed.
Obtains timely authorization of 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 that increase and stabilize conversion and generates referrals both locally and regionally.
Maintains profiles on each payer, including case managers, medical directors, P2P, and appeal information.
Identifies payer communication preferences and utilizes them 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, including surveying for satisfaction and conducting off-site meetings.
Evaluates Non-Medicare benefits, reviews benefits with Admissions Coordinator for possible risk, and applies written guidelines to reduce or manage risk.
Answers phone with appropriate behavior and ensures back-up when unavailable.
Works closely with Admissions Coordinator to apply correct accommodation code per contract and billing/reimbursement requirements.
Tracks approval and denials through TOC.
Ensures outstanding customer service for all customers.
Performs other duties as requested.