Rehab Authorization and Appeals Specialist

Atrium Health • Charlotte, NC

217d

About The Position

The primary purpose of this position is to increase rehabilitation admissions by screening potential rehabilitation clients and facilitating authorization and appeals. The role also involves coordinating legal support and hearings, as well as providing education and advocacy for patient access to rehabilitation services.

Requirements

• Bachelor’s Degree required.
• Trained and qualified clinician: RN, PT, OT, SLP, N or PA.
• Current license in respective clinical field required.
• 3-5 years experience in acute care hospital and/or inpatient rehabilitation setting.
• Must have a valid driver's license and a vehicle to conduct such travel.
• Strong communication skills, organization skills, attention to detail, ability to problem solve, and analyze data.
• Knowledge of Microsoft applications including Excel, PowerPoint, and Word.

Responsibilities

• Understand and maintain knowledge of Inpatient Rehabilitation Facilities (IRF) Medicare Criteria and necessary functional and medical complexity that would qualify a given patient for IRF.
• Identify patients who would benefit from IPR and make appropriate post-acute DC recommendations.
• Utilize excellent knowledge of appropriate medical and rehab documentation and make recommendations to internal stakeholders to improve documentation that supports IRF admission as appropriate.
• Serve as an expert in managing denials and appeals for IRF authorization process.
• Diligently communicate with payors by phone, fax, or email to follow up on authorizations and appeals within the expedited timeframe.
• Manage accurate data gathering and reporting for No Delay Program for Inpatient Rehabilitation (IPR) and rehab authorizations and appeals in cooperation with Data Analysts.
• Collaborate with teammates involved in data analysis for reporting outcomes.
• Serve as a resource for teammates regarding EPIC Rehab Auth Workflow.
• Articulate reasoning for No Delay Authorization in a way that is understandable by multiple audiences and for people of different backgrounds including patients, families, and teammates.
• Communicate with patients and their families about their specific appeal situation and provide follow up.
• Obtain a properly executed Appointment of Representative (AOR) form as needed and follow HIM guidance for scanning to the medical record.
• Provide timely updates to all necessary teams and document appropriately in medical record when expedited appeals are upheld and case will be considered for Administrative Law Judge (ALJ) hearing review.
• Serve as a contact person for ALJ offices and communicate with legal assistants regarding matters related to hearings and case files.
• Demonstrate a high degree of comfort and confidence working with a team of physicians and lawyers.
• Be prepared to speak in hearings to a judge and legal teams.
• Identify and communicate areas for continuous improvement within the defined process of No Delay Authorizations.
• Demonstrate comfort in navigating, understanding, and communicating information within the electronic health record.
• Complete other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees