Select Specialty Hospitals of Miami and Miami Lakes
Critical Illness Recovery Hospital
Prior Authorization Specialist / Payor Relations Specialist (Precert Nurse)
**This is not a remote position**
At Select Specialty/Regency Hospitals, a division of Select Medical, we care for chronically and critically ill or post-ICU patients who require extended hospital care. 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!
Using discretion and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Critical Illness Recovery Hospitals.
- 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 critical illness recovery 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.
We are seeking results-driven team players. Qualified candidates must be passionate about providing superior quality in all that they do.
- At least two (2) years of direct experience in third party reimbursement.
- Must be a Registered Nurse (RN) or Licensed Practical Nurse (LPN).
- Bilingual: English/Spanish
- Experience working with Excel and databases
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.
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