Payor Relations Specialist

Riverside Rehabilitation Hospital; Yorktown (VA); On-site; USD 75,000 - 105,000; Full time

Job summary

Riverside Rehabilitation Hospital, in partnership with Select Medical, seeks a Payor Relations Specialist / Prior Authorization Specialist (RN or LPN required) to manage pre-certification and prior authorization for admissions. You will work to obtain timely payor approvals, communicate with payors, and support revenue cycle activities.

The role requires RN or LPN licensure, at least two years of reimbursement experience, and a focus on improving conversion and reducing financial risk.

Qualifications

• At least two (2) years of direct experience in third party reimbursement.
• Must be a Registered Nurse (RN) or Licensed Practical Nurse (LPN).

Responsibilities

• 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.
• 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.
• 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.

Skills

Third party reimbursement experience

Education

RN or LPN license

Tools

Excel

Job description

In Partnership with Select Medical

Payor Relations Specialist / Prior Authorization Specialist ( RN or LPN required )

Annual salary: $75,000 to $105,000 *

Riverside Rehabilitation Hospital

In Partnership with Select Medical

Payor Relations Specialist / Prior Authorization Specialist ( RN or LPN required )

Annual salary: $75,000 to $105,000 *

Starting salary is dependent on years of relevant work experience.

Full-Time, Monday - Friday, 8 am - 5 pm

Who We Are

Select Medical is the nation’s leading provider of long-term acute care services and one of the largest providers of healthcare in the U.S. Across our network of over 47,000 employees, 120 inpatient hospitals, 1600 outpatient therapy centers, and 500 urgent care facilities, our employees are guided by a set of core values and cultural behaviors that drive our hospital teams to deliver an exceptional patient experience and an exceptional employee experience.

What You Will Do As a Payor Relations Specialist

We are looking for like-minded professionals who will be Champions of the Select Medical Way, which includes putting the patient first, helping to improve quality of life for the community in which you live and work, continuing to develop and explore new ideas, providing high-quality care and doing well by doing what is right.

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.

We are seeking results-driven team players. Qualified candidates must be passionate about providing superior quality in all that they do.

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