Payor Relations Specialist -LVN, RN Case Manager- Baylor Rehab - Dallas
Baylor Scott & White Institute for Rehabilitation
Prior Authorization Nurse - Payor Relations Specialist
Candidates should be an LVN, RN, or RN Case Manager.
This position is on-site at our hospital, and is not a remote position.
Using discretion and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Rehabilitation Hospital.
- 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.
- 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.
- 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.
- Maintain relationship profile by payor for payor case managers and medical directors.
- Identifies by payor communication preference and utilizes to maximize results.
- Encourages and models teamwork, communication and collaboration with other departments to include but not limited to the transion of of patients into the rehabilitation hospital.
- Serves as a resource to the Business Development Team educating them on payor preference to promote exceptional customer service and efficient processes
- 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.
- 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.
- Reviews Medicare benefits through Vision Share and Common Working and accurately accounts for whether the patient has traditional Medicare or a Medicare Advantage plan.
- Answers phone with appropriate behavior and ensures back-up when not available or out of the office.
- Works closely with Admissions Coordinator to apply correct accommodation code per contract as well as billing/reimbursement requirements
- Tracks approval and denials through erehab
- Ensure outstanding customer service for all customers.
- Performs other duties as requested.
- Requires a Registered Nurse or Licensed Vocational Nurse/ Licensed Practical Nurse.
- Previous experience within a physical rehabilitation setting preferred
- At least two (2) years of direct experience in third party reimbursement.
- Experience working with Excel and databases
Baylor Scott & White Institute for Rehabilitation, a joint venture between Baylor Scott & White Health and Select Medical, carries a well-known reputation for patient care and exceptional quality outcomes. We serve all people through exemplary healthcare, education, research and community service. Since opening in 1981, our flagship inpatient rehab hospital in Dallas has received repeated recognition by U.S. News & World Report as one of the best rehab hospitals in the nation. All of our inpatient hospitals are accredited by The Joint Commission, including specialty accreditation for our stroke rehab programs. And for five consecutive years we have been recognized as a “Best Place to Work” by the Dallas Business Journal.
With the combined expertise of our joint venture partners, Baylor Scott & White Rehabilitation has become one of the most recognized and largest rehabilitation providers in the nation. We have continuously grown in size, scope and excellence across North Texas, and in the summer of 2018 our footprint has expanded to include new partners in Central Texas. With this expansion, we have more than 2,300 talented, caring and compassionate team members working in the following environments:
- 4 inpatient rehab hospitals (free-standing)
- 2 inpatient rehab units in Baylor Scott & White Health acute hospitals
- 9 acute therapy units in Baylor Scott & White Health acute hospitals
- 87 outpatient therapy locations (and growing)
- A home health division covering all of North Texas
Select Medical is an equal opportunity employer committed to dealing with employees in a nondiscriminatory manner and based on job-related qualifications and abilities. The Company will recruit, hire, train, and promote all persons without regard to race, color, sex, religion, national origin, veteran status, age (40 and over), marital status, disability or history of disability (except where physical or mental abilities are a bona fide occupational qualification) or any other protected status.
To complete your application on another device, simply send it to yourself here. We do not store this email or use it for any purpose other than forwarding this job to the name and email that you designate.