Select Medical

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Payor Relations Specialist

Payor Relations Specialist

Job ID 
61955
Location 
US-OH-Cincinnati
US-OH-Cincinnati
US-OH-Cincinnati
Experience (Years) 
2
Category 
Clinical - Case Manager
Street Address 
10500 Montgomery Rd
Company 
Select Specialty Hospital
Position Type 
Full Time-Regular
Recruiter email address 
..

More information about this job

Overview

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 Hospitals.

Responsibilities

JOB-SPECIFIC DUTIES/COMPETENCIES                                            

  • 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.  
  • 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.
  • 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.
  • Completes billing and reimbursement and shares it with the Admissions Coordinator and Case Management.  
  • Ensure outstanding customer service for all customers.

Qualifications

QUALIFICATIONS                                                        

  • Requires a Registered Nurse or Licensed Vocational Nurse/ 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