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 -
- Initiates and completes patient authorizations.
- 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 relationship profile by payor for payor case managers and medical directors.
Collaborate with Business Development/Case Management -
- Encourages a smooth and effective hand-off of patients to Case Management to ensure continuity in patient care plan.
- Serves as a member of the Business Development Team by educating the team on payor preference to avoid backtracking and rework.
- 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 -
- 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.
- Completes billing and reimbursement and shares it with the Admissions Coordinator and Case Management team.
Qualifications:
Minimum Qualifications:
- At least two (2) years of direct experience in third party reimbursement.
- Must be a Registered Nurse (RN) or Licensed Practical Nurse (LPN).
Preferred Experience:
- Experience working with Excel and databases
Additional Data:
Benefits:
- An extensive and thorough orientation program.
- Monday through Friday schedule; six (6) paid holidays.
- Develop collaborative relationships with patients and their families.
- Paid Time Off (PTO) and Extended Illness Days (EID).
- Health, Dental, and Vision insurance; Life insurance; Prescription coverage.
- A 401(k) retirement plan with company match.
- Short and Long Term Disability.
- Personal and Family Medical Leave.