Rehabilitation Authorization and Appeals Specialist PRN at American Addiction Centers

Charlotte, North Carolina, United States -

Full Time

Start Date

Immediate

Expiry Date

21 Aug, 26

Salary

53.25

Posted On

23 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Insurance Authorization, Appeals Management, Clinical Documentation, Medicare Criteria, Case Management, Patient Communication, Data Reporting, EPIC EHR, Public Relations, Problem Solving, Excel, Power Point

Industry

Hospitals and Health Care

Description

Department: 37500 Carolinas Rehabilitation: Charlotte - Administration: Rehabilitation Status: Part time Benefits Eligible: No Hours Per Week: 0 Schedule Details/Additional Information: Additional contacts regarding this position: Calvin Hung, Robert Larrison, and Dr. Brian Moore Pay Range $35.50 - $53.25 Clinical experience in inpatient rehabilitation as a PT or OT Preferred (RN ok ), understanding of the inpatient rehabilitation insurance authorization and appeals process, detail oriented is a must. • Essential Functions • Understands and maintains knowledge of Inpatient Rehabilitation Facilities (IRF) Medicare Criteria and necessary functional and medical complexity that would qualify a given patient for IRF • Identifies patients who would benefit from IPR and makes appropriate post-acute DC recommendations • Utilizes excellent knowledge of appropriate medical and rehab documentation and makes recommendations to internal stakeholders to improve documentation that supports IRF admission as appropriate • Serves as an expert in managing denials and appeals for IRF authorization process • Diligently communicates with payors by phone, fax, or email to follow up on authorizations and appeals within the expedited timeframe • Manages accurate data gathering and reporting for No Delay Program for Inpatient Rehabilitation (IPR) and rehab authorizations and appeals in cooperation with Data Analysts • Collaborates with teammates involved in data analysis for reporting outcomes • Serves as a resource for teammates regarding EPIC Rehab Auth Workflow • Articulates reasoning for No Delay/Care First Authorization in a way that is understandable by multiple audiences and for people of different backgrounds including patients, families, and teammates Communicates with patients and their families about their specific appeal situation and provides follow up • Obtains a properly executed Appointment of Representative (AOR) form as needed and follows HIM guidance for scanning to the medical record • Provides timely updates to all necessary teams and documents appropriately in medical record when expedited appeals are upheld and case will be considered for Administrative Law Judge (ALJ) hearing review • Serves as a contact person for ALJ offices and communicates with legal assistants regarding matters related to hearings and case files • Demonstrates a high degree of comfort and confidence working with a team of physicians and lawyers • Is prepared to speak in hearings to a judge and legal teams • Identifies and communicates areas for continuous improvement within the defined process of No Delay/Care First Authorizations • Demonstrates comfort in navigating, understanding, and communicating information within the electronic health record • Completes other duties as assigned Physical Requirements Requires frequent car travel, walking, standing, sitting, some lifting, reaching, bending, stooping, pushing and pulling. Must lift some articles up to twenty-five pounds. Can move about to accomplish tasks. Ability to clearly and concisely express and exchange ideas via spoken and written English word, conveying detailed information to others accurately and, on occasion, quickly. Must have excellent presentation skills and service excellence. Travel by car required with frequent day trips and occasional overnight travel about once per month Education, Experience and Certifications Bachelor’s Degree required. Licensed clinician required. Trained and qualified clinician such as RN, PT, OT, SLP, NP, PA. Must have a valid driver's license and a vehicle to conduct such travel. Public relations skills preferred. Experience in acute care hospital and/or IPR setting; communication skills; organization skills; attention to detail; and ability to problem solve. Knowledge of Excel, Power Point, and payor portals helpful. Patient Population Served Demonstrates knowledge of the principles of growth and development and demonstrates the skills and competency appropriate to the ages, culture, developmental stages, and special needs of the patient population served. Protected Health Information • Will limit access to protected health information (PHI) to the information reasonably necessary to do the job. Machines, Tools, and Equipment Related medical and office equipment and supplies Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview. About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits. This is Transformation One shared purpose brought us together. Now, as one of the 10 largest not-for-profit, integrated health systems in the United States, our combined strength and stability drives us forward. Starting with You Caring for nearly 3 million people has inspired a transformation. One in which the patient’s experience guides our vision and empowers us to offer new possibilities in our communities. Reshaping Access What is access? It’s offering more sites of care than any other health system in the Midwest. But there’s a new frontier. Access is exploring the latest technologies to deliver care to patients exactly where they are and exactly when they need it Inspiring Professionals With our dynamically inclusive workforce and strong connections to the places where we live and work, we’ll touch more lives and contribute to stronger and more vibrant communities. Transforming Care We’re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in: Cardiovascular Care Neurosciences Gynecology Oncology Pediatrics Primary Care Neurology Geriatrics Trauma Care

Responsibilities

Manage the insurance authorization and appeals process for Inpatient Rehabilitation Facilities, ensuring patients meet Medicare criteria. Coordinate with payors, legal teams, and physicians to resolve denials and represent cases in Administrative Law Judge hearings.