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Prior Authorization Specialist

2 months ago

Henderson, United States Dignity Health Rehabilitation Hospital Full time

Overview:

Dignity Health Rehabilitation Hospital

*A joint venture with Select Medical & Dignity Health*

Henderson, NV

Prior Authorization Specialist ( RN , LPN )

Working Onsite Required

Responsibilities:

Job 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.

  1. Follows the Select Workflow Process for initiating and completing patient authorizations. Takes full responsibility for following the Workflow Process and ensures each referral follows the process, from taking the initial referral until final disposition, acceptance or denial. As appropriate, submits the preadmission assessments completed by clinical liaisons to the insurance company.
  2. Ensures documentation meets standards and expectations by working and mentoring team as needed.
    Obtains timely authorization of all patients requiring pre-certification and is accountable for conversion percentage and results.
  3. 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. 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.
  4. Maintains profiles on each payer to include case managers and medical directors, P2P and appeal info.
  5. Identifies by payor communication preference and utilizes to maximize results.
  6. 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.
  7. Serves as a resource to the Business Development Team educating them on payor preference to promote exceptional customer service and efficient processes
  8. 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.
  9. 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.
  10. Answers phone with appropriate behavior and ensures back-up when not available or out of the office.
  11. Works closely with Admissions Coordinator to apply correct accommodation code per contract as well as billing/reimbursement requirements.
  12. Tracks approval and denials through TOC.
  13. Ensure outstanding customer service for all customers.
  14. Performs other duties as requested.


Qualifications:

Minimum Qualifications

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

Preferred Experience

  • 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.

Other benefits of this position include:

  • Excellent Orientation Program
  • Paid Time Off (PTO)
  • Extended Illness Days (EID)
  • Health, Dental, and Vision Insurance
  • Prescription Coverage
  • Life 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.