Prior Authorization Specialist - Inpatient Rehab
3 days ago
West Orange
Kessler Institute for Rehabilitation - West Orange West Orange NJ Prior Authorization Specialist/ Payor Relations Specialist ( RN LPN ) Full-Time Onsite required Salary range of $70000 - $100000 based on 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. • 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., • Maintains profiles on each payer to include case managers and medical directors P2P and appeal info., • 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 transition of patients into the critical illness recovery hospital or acute inpatient 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 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., • 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 TOC., • Ensure outstanding customer service for all customers., • 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 rehabilitationsetting preferred, • Start Strong:Extensive and thorough orientation program to ensure a smooth transition into our setting., • Recharge & Refresh:Generous PTO to maintain a healthy work-life balance, • Your Health Matters:Comprehensive medical/RX health vision and dental plan offerings, • Invest in Your Future:Company-matching 401(k) retirement plan as well as life and disability protection, • Ease The Burden:Company paid parking, • Your Impact Matters:Join a team of over 44000 committed to providing exceptional patient care Equal Opportunity Employer including Disabled/Veterans. Required Experience: Unclear Seniority Key Skills Sales Experience,Crane,Customer Service,Communication skills,Heavy Equipment Operation,Microsoft Word,Case Management,OSHA,Team Management,Catheterization,Microsoft Outlook Calendar,EHS Employment Type : Unclear Experience: years Vacancy: 1 Monthly Salary Salary: 70000 - 100000
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