Prior Authorization Specialist

16 hours ago


Frisco Texas, United States Baylor Scott & White Institute for Rehabilitation - Frisco Hospital Full time
Job Summary

Baylor Scott & White Institute for Rehabilitation - Frisco Hospital is seeking a skilled Prior Authorization Specialist to join our team. As a Prior Authorization Specialist, you will play a critical role in managing the pre-certification and prior authorization of referrals scheduled for admission to our Acute Inpatient Rehabilitation Hospital.

Key Responsibilities
  • Manage the pre-certification and prior authorization of referrals scheduled for admission to the Acute Inpatient Rehabilitation Hospital.
  • Follow the Select Workflow Process for initiating and completing patient authorizations.
  • Ensure documentation meets standards and expectations by working and mentoring team as needed.
  • Obtain timely authorization of all patients requiring pre-certification and be accountable for conversion percentage and results.
  • Ensure all policies governing commercial pre-certification and authorization are followed to minimize financial risk.
  • Develop relationships that increase and stabilize conversion as well as generate referrals both locally and regionally.
  • Maintain profiles on each payer to include case managers and medical directors, P2P and appeal info.
  • Identify by payor communication preference and utilize to maximize results.
  • Encourage and model 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.
  • Serve as a resource to the Business Development Team educating them on payor preference to promote exceptional customer service and efficient processes.
  • Maintain and further develop 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.
  • Evaluate Non-Medicare benefits as verified by the Central Business Office or Rehab Admissions Coordinator. Review benefits with Admissions Coordinator for possible risk and apply/completes written guidelines as necessary to reduce or manage risk.
  • Answer phone with appropriate behavior and ensure back-up when not available or out of the office.
  • Work closely with Admissions Coordinator to apply correct accommodation code per contract as well as billing/reimbursement requirements.
  • Track approval and denials through TOC.
  • Ensure outstanding customer service for all customers.
Requirements
  • Licensure as a Registered Nurse or LVN/LPN is required.
  • 2 years of direct experience in third party reimbursement required.
  • Preferred Experience: Will consider additional clinical licenses, if candidate also has extensive experience with prior authorizations and/or utilization review.
  • Previous Experience within a physical rehabilitation setting preferred.
  • Experience working with Excel and databases.


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