Prior Authorization Specialist ( RN , LPN )

Cleveland Clinic Rehab Hospital - Beachwood

*A joint venture with Select Medical & Cleveland Clinic*

Beachwood, OH

Payor Relations Specialist / Prior Authorization Specialist ( RN or LPN required )

This position has remote capability

Full-Time, Monday - Friday, 8am - 5pm EST

Who We Are 

Select Medical is the nation’s leading provider of long term acute care services and one of the largest providers of healthcare in the U.S. Across our network of over 47,000 employees, 120 inpatient hospitals, 1600 outpatient therapy centers and 500 urgent care facilities, our employees are guided by a set of core values and cultural behaviors that drive our hospital teams to deliver an exceptional patient experience and an exceptional employee experience.                                                                                          

Job Responsibilities

Using discretion and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute Inpatient Rehabilitation Hospital.

1. 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.
2. 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.
3. 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.
4. Maintains profiles on each payer to include case managers and medical directors, P2P and appeal info.
5. Identifies by payor communication preference and utilizes to maximize results.
6. Encourages and models teamwork, communication and collaboration with other departments to include but not limited to the transition of patients into the critical illness recovery hospital or acute inpatient rehabilitation hospital.
7. Serves as a resource to the Business Development Team educating them on payor preference to promote exceptional customer service and efficient processes
8. 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.
9. Evaluates Non-Medicare benefits as verified by the Central Business Office or Rehab Admissions Coordinator. Reviews benefits with Admissions Coordinator for possible risk and applies/completes written guidelines as necessary to reduce or manage risk.
10. Answers phone with appropriate behavior and ensures back-up when not available or out of the office.
11. Works closely with Admissions Coordinator to apply correct accommodation code per contract as well as billing/reimbursement requirements.
12. Tracks approval and denials through TOC.
13. Ensure outstanding customer service for all customers.
14. Performs other duties as requested.

Minimum Qualifications

• Licensure as a Registered Nurse or LVN/LPN is required
• 2 years of of direct experience in third party reimbursement required

Preferred Experience

• Previous Experience within a physical rehabilitation setting preferred
• Experience working with Excel and databases

Why Join Us:

• Start Strong: Extensive and thorough orientation program to ensure a smooth transition into our setting
• Recharge & Refresh: Generous PTO and Paid Sick Time for full-time team members to maintain a healthy work-life balance
• Your Health Matters: Comprehensive medical/RX, health, vision, employee assistance program (EAP)  and dental plan offerings for full-time team members
• Invest in Your Future:Company-matching 401(k) retirement plan, as well as life and disability protection for full-time team members
• Your Impact Matters:Join a team of over 44,000 committed to providing exceptional patient care

Equal Opportunity Employer, including Disabled/Veterans.