Select Medical

Receive alerts when this company posts new jobs.

Similar Jobs

Job Details

Payor Relations Specialist

at Select Medical

Posted: 1/9/2020
Job Reference #: 118436
Categories: Other/General
Keywords: company, commercial

Job Description

  • Job ID
    118436
    Location
    US-FL-Miami Lakes | US-FL-Miami
    Experience (Years)
    2
    Category
    Clinical - Case Manager
    Street Address
    14001 NW 82nd Ave
    Company
    Select Specialty Hospital
    Position Type
    Full Time Regular
  • Overview

    Payor Relations Specialist (Precert Nurse)

    JOB SUMMARY

    Using discretion and independent judgment, the 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

    Coming Soon!