Payor Relations Specialist

Payor Relations Specialist

Using discretion and independent judgment, the Payor Relations Specialist (PRS), Acute Rehab manages the pre-certification and prior authorization of referrals scheduled for admission to the Rehabilitation Hospital. They provide mentoring and guidance for the team as needed. They obtain timely authorization of all patients requiring precertification and is accountable for conversion percentage and results.

• The PRS follows ERH workflow process for initiating and completing patient authorizations. The successful Payor Relations Specialist takes full responsibility 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 ensuring that documentations meets standards and expectations. They develop relationships with the insurance company representatives that increase and stabilize conversion as well as generates referrals both locally and regionally. This may include identifying relationship opportunities for self and others to include but not limited to CEO, DBD, CLs and Case Management team that may help grow relationships and impact results. Maintains relationship profile information by payor for case managers and medical directors, which includes communication preference. The successful PRS utilizes this information to maximize results.
• They serve as the resource to the Business Development Team educating them on payor preferences to promote exceptional customer service and efficient processes. They maintain and further develop relationships with customers, which may include but not limited to surveying for satisfaction with the work of ERH and off-site meetings with the customer. Evaluating commercial benefits, reviewing benefits with the Admission coordinator and liaisons for possible risk and manages risk wherever possible. This position is also responsible for negotiating rates with the assistance of the Bus Dev Dir and CEO for Workers comp claims and letters of agreement with non-contracted insurance companies or privately paying patients.
• The PRS reviews Medicare benefits and accurately accounts for whether the patient has traditional Medicare or Medicare advantage. The person in the PRS role encourages and models teamwork, communication and collaboration with other departments to include but not limited to the transition of service and efficient processes. Excellent professional business communication is essential to this job. This includes phone, email, fax or any other form of communication with internal and external customers. Ensures back-up when not available or out of office to prevent missed calls/emails pertaining to admissions.

Job Qualifications: Requires a Registered Nurse; BSN preferred Previous experience within a physical rehabilitation setting preferred At least two years of direct experience in third party reimbursement Experience working with Excel and databases Will consider a LVN or LPN with either extensive experience/skills and/or obtaining a RN within one year of employment.

Emory Healthcare (EHC), part of Emory University (EUV), is the most comprehensive academic health system in Georgia and the first and only in Georgia with a Magnet designated ambulatory practice. We are made up of 11 hospitals-4 Magnet designated, the Emory Clinic, and more than 425 provider locations. The Emory Healthcare Network, established in 2011, is the largest clinically integrated network in Georgia, with more than 3,450 physicians concentrating in 70 different subspecialties.

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare's Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.