Overview:
Select Specialty Hospitals
Critical Illness Recovery Hospital
Payor Relations Specialist ( RN , LPN )
This position will provide remote support to Select Specialty Hospitals in Charleston, Morgantown, Wheeling, Weirton
At Select Specialty Hospitals, a division of Select Medical, we care for chronically and critically ill or post-ICU patients who require extended hospital care.
Responsibilities:
As the Payor Relations Specialist, you will manage the pre-certification and prior authorization of referrals scheduled for admission to our hospital.
Communication with Payors -
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Initiates and completes patient authorizations.
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Obtains timely authorization of all patients requiring pre-certification and is accountable for conversion percentage and results.
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Ensures all policies governing commercial pre-certification and authorization are followed to minimize financial risk.
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Develops relationships that increase and stabilize conversion, as well as, generates referrals both locally and regionally.
- Maintains relationship profile by payor for payor case managers and medical directors.
Collaborate with Business Development/Case Management -
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Encourages a smooth and effective hand-off of patients to Case Management to ensure continuity in patient care plan.
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Serves as a member of the Business Development Team by educating the team on payor preference to avoid backtracking and rework.
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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.
Financial/Risk Responsibilities -
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Evaluates Commercial benefits as verified by the Central Business Office. Reviews benefits with Admissions Coordinator for possible risk and applies/completes written guidelines as necessary to reduce or manage risk.
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Completes billing and reimbursement and shares it with the Admissions Coordinator and Case Management team.
Qualifications:
Minimum Qualifications:
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At least two (2) years of direct experience in third party reimbursement.
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Must be a Registered Nurse (RN) or Licensed Practical Nurse (LPN).
Preferred Experience:
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Experience working with Excel and databases
Additional Data:
Benefits:
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An extensive and thorough orientation program.
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Monday through Friday schedule; six (6) paid holidays.
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Develop collaborative relationships with patients and their families.
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Paid Time Off (PTO) and Extended Illness Days (EID).
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Health, Dental, and Vision insurance; Life insurance; Prescription coverage.
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A 401(k) retirement plan with company match.
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Short and Long Term Disability.
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Personal and Family Medical Leave.
