Prior Authorization Specialist - Inpatient Rehab

				Overview:

Kessler Institute for Rehabilitation

West Orange, NJ

Prior Authorization Specialist/Payor Relations Specialist ( RN , LPN ) 

This is an onsite position only.

Advocate for patients to receive insurance coverage for the care and services they need, as a Prior Authorization Specialist.

Responsibilities:

As a Prior Authorization Specialist / Payor Relations Specialist (RN OR LPN) you will manage the pre-certification and prior authorization of referrals scheduled for admission to the acute inpatient rehabilitation hospital.

* Registered Nurse (RN) or Licensed Practical Nurse (LPN) required. 
* Initiates, completed patient authorizations, including preadmission assessments to insurance companies. 
* Exceptional customer service to increase, stabilize and grow conversions and referrals.
* Maintains documentation.
* 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.
* Tracks approval and denials through TOC.

Qualifications:

Minimum Qualifications

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

Preferred Experience

* Previous Experience within a physical rehabilitation setting preferred
* Experience submitting prior authorizations and/or utilization review preferred.
* Experience working with Excel and databases
			

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