Prior Authorization Specialist

2 weeks ago

Chicago, United States Select Medical Full time

Overview Rush Specialty Hospital Critical Illness Recovery Hospital + Inpatient Rehabilitation Hospital Location: Chicago, IL Prior Authorization Specialist (RN or LPN) Candidate must be located in Central Standard Time zone to be considered Opened in April 2024, Select Medical and Rush University System for Health celebrated the new RUSH Specialty Hospital opening on Chicago's West Side. Together as partners, they deliver a world-class acute to post-acute continuum of care for Chicago. The 100-bed facility combines both critical illness recovery and inpatient rehabilitation hospitals on the RUSH University Medical Center campus. The hospital features 44 critical illness recovery and 56 inpatient rehabilitation beds. Select Medical employs over 48,000 people across the country and provides quality care to approximately 70,000 patients each and every day across our four divisions. Our mission is to provide an exceptional patient care experience that promotes healing and recovery in a compassionate environment. Each employee plays a vital role in doing that by living our cultural behaviors - celebrating success, owning the future, being patient-centered, creating change, thinking first and building trust. Are you resourceful in overcoming obstacles? Are you a results-oriented team player? If you answered 'yes', consider an opportunity with us Responsibilities We are looking for valued employees 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. Qualifications Minimum Qualifications: Licensure as a Registered Nurse or LVN/LPN is required. 2 years of direct experience in third party reimbursement required. Preferred Experience: Previous Experience within a physical rehabilitation setting preferred. Experience working with Excel and databases. Must live in Central Standard Time zone to be considered for this position. Additional Data Select Medical strives to provide our employees with work-life balance, as we understand that happy employees have both fulfilling careers and fulfilling lives beyond our doors. An extensive and thorough orientation program. Monday through Friday schedule; six (6) paid holidays. Develop collaborative relationships with patients and their families. Paid Time Off (PTO) and Extended Illness Days (EID). Health, Dental, and Vision insurance; Life insurance; Prescription coverage. A 401(k) retirement plan with company match. Short and Long Term Disability. Personal and Family Medical Leave. We'd love for you to join the team 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. #J-18808-Ljbffr

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