Description

At SLP, our commitment is to provide love, attention and optimal care one resident at a time. We realize consistently fulfilling this commitment depends on the success of professionals like you, who build their careers with us. Together, we’re setting the standard in the delivery of rehabilitation, quality post-acute services and long-term care.

Your talent will make a difference every day and we will make it count for you!

Career Advantages We Offer:

• Medical, vision and dental insurance

• Employer-paid life insurance

• Paid time off

• Paid holidays

• Flexible schedule

• Long term growth and advancement opportunities

• And more….

Job Summary:

This managed care specialist is responsible for reviewing and verifying insurance benefits and obtaining authorizations for admission qualification to facilities. This position reports to the Centralized Intake Manager.

Responsibilities:

• Works collaboratively with team members ensuring appropriate patient admission and exceptional customer experience.
• Verify benefits for all skilled managed prior authorization request and obtain the initial authorization for skilled services for all managed care residents.
• Efficiently and effectively, work with sales and marketing team to ensure referrals are properly communicated and managed
• Communicate with center leaders for to partner on authorizations.
• Maintain appropriate logs to ensure insurance is verified and tracked
• Provide lists on alternate in network opportunities when needed to the sales and marketing team, as well as the centers.
• Follow up on pending authorizations daily and communicate status to the sales and marketing team and centers.
• Assist in data collection, monitoring, evaluation, and analyzing of problems for the purpose of developing and implementing protocols, policies, and procedures.
• Follow specific protocols, policies, procedures, and utilize established resources.
• Obtains appropriate clinical documentation to support services and/or reimbursement level and financial documentation to support the authorization.
• Communicate with the pharmacy for cost out needs of certain medications.
• Communicates information to ADPS and center sales/admissions teams, Administrator or Director of Nursing and Business Office Manager, when applicable and helps coordinates patient’s smooth transition into the center.
• Complete weekly and monthly reports as required.
• Develop and maintain relationships with referral sources; cooperate and collaborate with referral sources and colleagues.
• Assist the contract manager as needed regarding incorrect/expired TIN's, NPI's and contract issues as directed by the Managed Care Manager.
• Adheres to established HIPAA confidentiality standards of patient/resident and client location information.
• Assists with generating additional referrals from insurance companies when appropriate.
• Cross Train as a Central Intake Coordinator and fill in as needed
• Read and familiarize self with State and Federal Nursing Facility regulations.
• Stay current and familiarize self with current healthcare and community trends including but not limited to Alternative Payment Models and changes in accounts, competitors, or healthcare community.
• Exhibit excellent customer relationship skills including telephone and personal contact with all of the call center’s customer groups, i.e. physicians and their office staffs, nurses, vendors and fellow employees, etc.
• Read and familiarize self with Nursing Facility 5-Star program along with Center ratings and understand how to respond to referral sources/ family members/ potential patients about ratings.
• Establish and maintains a high degree of awareness and knowledge of the company’s medical staff, services, and special programs.
• Participates in off hour and weekend on call duty as assigned.
• All other duties as assigned.

Requirements

• 3-5 YEARS HEALTHCARE EXPERIENCE WITH BILLING AND INSURANCE KNOWLEDGE
• Experience in Medicare and Medicaid eligibility, billing, processes, and systems.
• Basic Computer Skills.
• Must be capable of maintaining regular attendance in a high-demand, fast-paced work environment with project/work deadlines.
• Must be capable of performing the essential functions of this job, with or without reasonable accommodation.
• Must demonstrate effective communication skills with team members, and leadership skills regarding projects, goals, objectives, and successes both verbally and written.

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.