Prior Authorization & Payor Relations Specialist (RN/LPN)

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

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.