Rehabilitation Authorization and Appeals Specialist PRN

Additional contacts regarding this position: Calvin Hung Robert Larrison and Dr. Brian Moore

Pay Range

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
Bachelors Degree required. Licensed clinician required. Trained and qualified clinician such
as RN PT OT SLP NP PA. Must have a valid drivers 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 CommitmenttoYou:

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 teammates 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 andShort- 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.