Prior Authorization Specialist - Weekend Only

Select Medical • Temple, TX

20d • Hybrid

About The Position

This position will work every Saturday and Sunday, 8 hours each day. This is primarily a work-from-home position, but to be considered, candidates must live within driving distance of Austin, TX, Temple, TX, and the DFW area. The Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute Inpatient Rehabilitation Hospital. They follow the Select Workflow Process for initiating and completing patient authorizations, taking full responsibility for ensuring each referral follows the process from initial referral until final disposition. This role involves submitting pre-admission assessments to insurance companies, ensuring documentation meets standards, and obtaining timely authorization for all patients requiring pre-certification. The specialist is accountable for conversion percentage and results, ensuring all policies governing commercial pre-certification and authorization are followed to minimize financial risk. They will develop relationships that increase and stabilize conversion and generate referrals, identify relationship opportunities for self and others within Select Medical, and maintain profiles on each payer. The role also involves encouraging teamwork, communication, and collaboration with other departments, serving as a resource to the Business Development Team by educating them on payor preference, and maintaining/developing relationships with customers. They will evaluate Non-Medicare benefits, review benefits with the Admissions Coordinator for possible risk, and apply/complete written guidelines as necessary. The specialist will answer the phone with appropriate behavior, ensure back-up when unavailable, and work closely with the Admissions Coordinator to apply correct accommodation codes and billing/reimbursement requirements. They will track approvals and denials through TOC and ensure outstanding customer service for all customers. Other duties may be requested.

Requirements

• Licensure as a Registered Nurse or LVN/LPN
• 2 years of direct experience in third-party reimbursement
• Candidates must live within driving distance of Austin, TX, Temple, TX, and the DFW area.

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.
• Follows the Select Workflow Process for initiating and completing patient authorizations.
• Takes full responsibility for following the “Workflow Process” and ensures each referral follows the process, from taking the initial referral until final disposition, acceptance or denial.
• Submits the pre-admission assessments completed by clinical liaisons to the insurance company.
• Ensures documentation meets standards and expectations by working and mentoring 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 as well as generates referrals both locally and regionally.
• Maintains profiles on each payer to include case managers and medical directors, P2P and appeal info.
• Identifies by payor communication preference and utilizes to maximize results.
• Encourages and models teamwork, communication and collaboration with other departments to include but not limited to the transition of patients into the critical illness recovery hospital or acute inpatient rehabilitation hospital.
• 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 which may include but are not limited to surveying for satisfaction with the work of Select Medical and off-site meetings with the customer.
• 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/completes written guidelines as necessary to reduce or manage risk.
• Answers phone with appropriate behavior and ensures back-up when not available or out of the office.
• Works closely with Admissions Coordinator to apply correct accommodation code per contract as well as billing/reimbursement requirements.
• Tracks approval and denials through TOC.
• Ensure outstanding customer service for all customers.
• Performs other duties as requested.

Benefits

• Extensive orientation program
• Opportunity for Advancement
• 401k (for Part time/Per Diem positions based on reaching 1,000 hours within their first anniversary or subsequent calendar year)
• Employee assistance program (for part-time employees)

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level
• Education Level: No Education Listed