Payor Relations Specialist

Overview

Select Specialty Hospitals

Critical Illness Recovery Hospital

Payor Relations Specialist ( RN , LPN )

This position will provide remote support to Select Specialty Hospitals in Charleston, Morgantown, Wheeling, Weirton

At Select Specialty Hospitals, a division of Select Medical, we care for chronically and critically ill or post-ICU patients who require extended hospital care. 

Responsibilities

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:

• At least two (2) years of direct experience in third party reimbursement.
• Must be a Registered Nurse (RN) or Licensed Practical Nurse (LPN).

Preferred Experience:

• Experience working with Excel and databases

Additional Data

Benefits:

• 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.