Interim Payor Relations Specialist Job ID 295064

Location US-PA-Mechanicsburg

Experience (Years) 3

Category Clinical - Case Manager

Street Address 4714 Gettysburg Road

Company Select Medical

Position Type Full Time

Overview

Interim Payor Relations Specialist JOB SUMMARY Using discretion and independent judgment, the Interim Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to Select Specialty/Regency Hospital.

Responsibilities

JOB-SPECIFIC DUTIES/COMPETENCIES Communication with Payors Initiate and complete patient authorizations. Ensure each referral follows the process, from taking the initial referral until final disposition, acceptance or denial. 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. This may include identifying relationship opportunities for self and others within Select Medical to include but not limited to Chief Executive Officer, Director of Business Development, Clinical Liaisons, Admissions Coordinator and Case Management team that may help grow relationships and impact results. Maintain relationship profile by payor for payor case managers and medical directors. Identifies by payor their preference or uses the best practice coversheet and submission portfolio to the insurance company to maximize results Encourages and models teamwork, communication and collaboration with other departments to include but not limited to a smooth and effective hand off of patients to Case Management to ensure continuity in patient care plan. Ensure outstanding customer service for all customers. Collaborate with Business Development/Case Management Encourages and models teamwork, communication and collaboration with other departments to include but not limited to 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 educating the team on payor preference to avoid backtracking, rework and increase customer service through an effective and efficient process. 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.

Qualifications

QUALIFICATIONS Requires a Registered Nurse or Licensed Practical Nurse. At least two (2) years of direct experience in third party reimbursement.

Additional Data

Benefits At Select Medical, our full-time employees enjoy 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 full-time benefits 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 with employer matching Personal and Family Medical Leave Join the network of over 40,000 employees with huge growth and relocation opportunities Join a Select Team of Excellence Today! Apply now! EOE

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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.