Prior Authorization Nurse

				Overview:

Critical Illness Recovery Hospital

Prior Authorization Nurse

At Select Specialty/Regency Hospitals, a division of Select Medical, we care for chronically and critically ill or post-ICU patients who require extended hospital care. Select Medical employs over 55,000 people across the country and provides quality care to approximately 70,000 patients each and every day across our four divisions. 

Our mission is to provide an exceptional patient care experience that promotes healing and recovery in a compassionate environment. Each employee plays a vital role in doing that by living our cultural behaviors - celebrating success, owning the future, being patient-centered, creating change, thinking first and building trust.

Responsibilities:

We are looking for  employees who will be champions of the Select Medical Way, which includes putting the patient first, helping to improve quality of life for the community in which you live and work, continuing to develop and explore new ideas, providing high-quality care and doing well by doing what is right.

As the Payor Relations Specialist, you will manage the pre-certification and prior authorization of referrals scheduled for admission to our hospital. 

Communication with Payors -

* Initiates and completes patient authorizations.
* 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. 
* Maintains relationship profile by payor for payor case managers and medical directors.

Collaborate with Business Development/Case Management -

* Encourages 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 by educating the team on payor preference to avoid backtracking and rework.
* 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 team.

Qualifications:

Minimum Qualifications:

* At least two (2) years of direct experience in third party reimbursement.
* Must be a Registered Nurse (RN) or Licensed Practical Nurse (LPN).

Preferred Experience:

* Experience working with Excel and databases
			

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