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Other
professional certificate
401k, Employee Assistance Program
Posted 21d ago
Apply by Jul 22
~16 hrs/week
Responsibilities
Manage the pre-certification and prior authorization process for referrals to the Acute Inpatient Rehabilitation Hospital. Develop and maintain relationships with payers and internal teams to maximize conversion rates and minimize financial risk.
Requirements
Requires licensure as a Registered Nurse (RN) or LVN/LPN and at least 2 years of direct experience in third-party reimbursement. Experience in physical rehabilitation settings and proficiency with Excel and databases are preferred.
Full job description
Overview
Baylor Scott & White Institute for Rehabilitation
A joint venture with Select Medical & Baylor Scott & White
This position will work every Saturday and Sunday, 8 hours each day
This is primarily a work-from-home position, but to be considered, candidates must live within driving distance of Austin, TX, Temple, TX, or the DFW area.
Responsibilities
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.
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.
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.
Performs other duties as requested.
Qualifications
Minimum Qualifications
2 years of direct experience in third-party reimbursement
Preferred Experience
Previous Experience within a physical rehabilitation setting preferred
Experience working with Excel and databases
Licensure as a Registered Nurse or LVN/LPN
Additional Data
Why Join Us:
Start Strong: Extensive orientation program to ensure a smooth transition into our setting.
Opportunity for Advancement: Demonstrate your skills and dedication, which could lead to potential full-time opportunities
Foster Well-being: We offer benefits that support the financial, work/life, and emotional well-being of you and your family members. Part time/Per Diem positions are eligible for 401k based on reaching 1,000 hours within their first anniversary or subsequent calendar year. We also offer our employee assistance program to part-time employees.
Your Impact Matters: Join a team of over 44,000 committed to providing exceptional patient care
Equal Opportunity Employer, including Disabled/Veterans
Baylor Scott & White Institute for Rehabilitation is a partnership between Baylor Scott & White Health and Select Medical. Its expansive rehabilitation network is one of the largest in Texas with four rehabilitation hospitals (in Dallas, Fort Worth, Frisco and Lakeway), one rehabilitation unit located in Baylor Scott & White Medical Center - Irving and more than 100 outpatient clinics located throughout North and Central Texas. Baylor Scott & White Institute for Rehabilitation promotes a patient-centric environment with employees who have a calling to help patients get back their independence after a debilitating injury. In addition, Baylor Scott & White Institute for Rehabilitation’s Continuum of Care philosophy ensures quality care throughout the entire rehabilitation process. Perhaps that's one reason why U.S. News & World Report and Newsweek ranks Baylor Scott & White Institute for Rehabilitation as one of "America's Best Hospitals."
Offices: Dallas, Texas 75246-2094, US · Lakeway, Texas 78734, US
Baylor Scott & White Institute for Rehabilitation is a partnership between Baylor Scott & White Health and Select Medical. Its expansive rehabilitation network is one of the largest in Texas with four rehabilitation hospitals (in Dallas, Fort Worth, Frisco and Lakeway), one rehabilitation unit located in Baylor Scott & White Medical Center - Irving and more than 100 outpatient clinics located throughout North and Central Texas. Baylor Scott & White Institute for Rehabilitation promotes a patient-centric environment with employees who have a calling to help patients get back their independence after a debilitating injury. In addition, Baylor Scott & White Institute for Rehabilitation’s Continuum of Care philosophy ensures quality care throughout the entire rehabilitation process. Perhaps that's one reason why U.S. News & World Report and Newsweek ranks Baylor Scott & White Institute for Rehabilitation as one of "America's Best Hospitals."
Offices: Dallas, Texas 75246-2094, US · Lakeway, Texas 78734, US