- Prior Authorization Specialist/ Payor Relations Specialist ( RN , LPN )
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Prior Authorization Specialist - Saint Louis, MO, United States - SSM Health Rehabilitation Hospital
Description
SSM Health Rehabilitation Hospital*A joint venture with Select Medical & SSM Health
Using discretion and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute Inpatient Rehabilitation Hospital.
Ensures all policies governing commercial pre-certification and authorization are followed to minimize financial risk.This may include identifying relationship opportunities for self and others within Select Medical to include but not limited to CEO, DBD, CLs, Admissions Coordinator and Case Management team that may help grow relationships and impact results.
Maintains profiles on each payer to include case managers and medical directors, P2P and appeal info.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.
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.
2 years of of direct experience in third party reimbursement required
Previous Experience within a physical rehabilitation setting preferred
Experience working with Excel and databases
Additional Data:
At our rehabilitation hospitals, our intense focus on high-quality results creates a challenging, fast-paced and extremely rewarding environment. We offer a comprehensive benefits package with a variety of options to meet your healthcare needs.
Health, Dental, and Vision Insurance
Short- and Long-Term Disability
Continuing Education and Tuition Reimbursement
401(k) Retirement Plan
Personal and Family Medical Leave
A network of over 40,000 employees with huge growth and relocation opportunities
**Select Medical is committed to having a workforce that reflects diversity at all levels and is an equal opportunity employer. Qualified applicants are considered for employment, and employees are treated during employment without regard to race, color, religion, national origin, citizenship, age, sex, sexual orientation, gender identity, marital status, ancestry, physical or mental disability, veteran status, or any other characteristic protected under applicable law.
