Omaha, Nebraska
Payor Relations Specialist (Precert Nurse) Job Opening in Omaha, Nebraska - 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 Hospital.
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
Requires a Registered Nurse or Licensed Vocational Nurse/ Licensed Practical Nurse.
At least two (2) years of direct experience in third party reimbursement.
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
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EOE
Job Type: Full-time
Job Location:
Omaha, NE
Required experience:
acute care: 2 years
prior : 2 years
Required license or certification:
RN or LPN/LVN
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