Prior Authorization Specialist - Part-Time

SSM Health; Peoria (AZ); Remote; USD 24,000 - 40,000; Part time

Job summary

SSM Health is seeking a Part-Time Prior Authorization Specialist (RN or LPN) to work weekends remotely. This role involves managing patient pre-certifications, ensuring documentation standards, and working closely with team members to provide excellent customer service. Join a dedicated team focused on exceptional patient care and enjoy benefits like comprehensive health plans and generous PTO.

Benefits

Generous PTO

Comprehensive medical, RX, vision, and dental plans

Company-matching 401(k)

Company-paid parking

Qualifications

• Minimum 2 years of experience in third-party reimbursement.
• Previous experience in a physical rehabilitation setting preferred.

Responsibilities

• Manage pre-certification and authorization of referrals for admission.
• Ensure all policies are followed to minimize financial risk.
• Develop relationships to increase conversion rates.

Skills

Discretion

Teamwork

Communication

Collaboration

Education

Licensure as a Registered Nurse or LVN/LPN

Tools

Excel

Databases

Job description

Overview

Banner Rehabilitation Hospitals

*A joint venture with Select Medical & Banner Health*

Peoria, AZ

Prior Authorization Specialist (RN or LPN) - Part-Time Weekends

This is a Remote position

This position requires working every Saturday and Sunday, 8 hours each day

Must live within a commutable distance of Maricopa County, AZ

Responsibilities

• 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.
• Follows the Select Workflow Process for initiating and completing patient authorizations. Takes full responsibility for following the process from initial referral to final disposition, acceptance, or denial. Submits preadmission assessments completed by clinical liaisons to the insurance company as appropriate.
• Ensures documentation meets standards and expectations by working and mentoring team members as needed. Obtains timely authorization for 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 to increase and stabilize conversion rates and generate referrals locally and regionally. This may include identifying relationship opportunities within the organization, such as with the CEO, DBD, Clinical Liaisons, Admissions Coordinators, and Case Management team, to help grow relationships and impact results.
• Maintains profiles on each payer, including case managers and medical directors, P2P, and appeal information.
• Identifies communication preferences by payor and utilizes this information to maximize results.
• Encourages and models teamwork, communication, and collaboration with other departments, including patient transition teams into the critical illness recovery hospital or acute inpatient rehabilitation hospital.
• Serves as a resource to the Business Development Team, educating them on payor preferences to promote exceptional customer service and efficient processes.
• Maintains and further develops relationships with customers, which may include surveying for satisfaction and off-site meetings.
• Evaluates Non-Medicare benefits as verified by the Central Business Office or Rehab Admissions Coordinator. Reviews benefits with the Admissions Coordinator to assess risk and applies written guidelines to reduce or manage this risk.
• Answers phone calls professionally and ensures coverage when unavailable or out of the office.
• Works closely with the Admissions Coordinator to apply correct accommodation codes per contract and billing/reimbursement requirements.
• Tracks approvals and denials through TOC.
• Ensures outstanding customer service for all customers.
• Performs other duties as requested.

Qualifications

Minimum Qualifications

• Licensure as a Registered Nurse or LVN/LPN is required.
• At least 2 years of direct experience in third-party reimbursement is required.

Preferred Experience

• Previous experience within a physical rehabilitation setting is preferred.
• Experience working with Excel and databases is preferred.

Additional Data

Why Join Us:

• Start Strong: Extensive orientation program to ensure a smooth transition.
• Recharge & Refresh: Generous PTO to support work-life balance.
• Your Health Matters: Comprehensive medical, RX, vision, and dental plans.
• Invest in Your Future: Company-matching 401(k), life, and disability insurance.
• Ease The Burden: Company-paid parking.
• Your Impact Matters: Join a team of over 44,000 dedicated to exceptional patient care.

Equal Opportunity Employer, including Disabled/Veterans.