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Rehab Services Specialist - Part-time, Days

Location Lake Forest, Illinois Business Unit Northwestern Medical Group Job REQID 10546 Job Function Customer Service Shift Day Job (1st) Apply Now

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better healthcare, no matter where you work within the Northwestern Medicine system. At Northwestern Medicine, we pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. Ready to join our quest for better?

Description

The Rehab ServicesSpecialist reflects the mission, vision, and values of Northwestern Medicine (NM), adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. 

Northwestern Medical Group (NMG) is committed to providing our communities the highest quality health care through exceptional access to state-of-the-art clinical services with compassionate and personal care.

The Rehab Services Specialist supports the Rehab Services team to efficiently communicate with payors and ensure timely treatment authorizations and insurance coverage for Rehab Services patients. This position ensures continuity of billing, collections, and other services through expertise in and across specific discipline(s) for third party payors.

Responsibilities:

  • Maintains accurate and up-to-date knowledge of authorization and certification guidelines and processes for all insurance payors contracted within the NM system. 
  • Is familiar with out-of-network processes / requirements for other insurance payors frequently seen in the NM service area.
  • Verifies therapy-specific insurance benefits for rehab services patients as determined by the financial services department during the registration process, identifying benefits for the services, limitations, and authorization requirements for both primary and secondary carriers.
  • Ensures patient pre-certification, if required, is obtained through registration staff.
  • Tracks and assures compliance with payor requests for information and communicates payor requests to appropriate treating therapist/personnel as needed.
  • Communicates clinical information provided by the treating therapist with all payors using a variety of methods, including faxing, web entry, and verbal communication.
  • Obtains timely payor determinations regarding authorization of treatment and accurately records and conveys the determination to the treating therapist.
  • Documents and communicates denial information, and remits appeals initiated by treating therapist in collaboration with Patient Accounting.
  • Obtains, through individual clinic sites, accurate insurance updates/changes from patients each month, communicating any changes that might occur to registration
  • Collaborates with Patient Accounting/Billing department concerning any patient and /or insurance issues, including all insurance and authorization information, as well as potential referral of patients to Financial Assistance team
  • Provides feedback to staff and management as needed regarding payor guidelines, issues, and determinations.
  • Communicates possible out-of-network status to the treating therapist and FMU.
  • Maintains up-to-date payor contact list.
  • Actively monitor therapists’ schedules including new evaluations, treatment plans and/or cancellations.
  • Optimizes therapists’ schedules by patient wait list outreach and scheduling. 
  • Support therapists and patients with point of service scheduling for a treatment series.
  • Ensures responses to patient and customer inquiries and provides assistance to others utilizing effective communications and interpersonal skills.
  • Assists with data preparation and the creation of presentation materials as needed
  • Completes other duties as assigned by director or manager, including all duties as described for the senior secretary position as needed.
  • Upholds the Northwestern Medicine policy on patient confidentiality. Meets and /or exceeds departmental, divisional, and institutional goals.
  • Adheres to NM, divisional and departmental quality standards and participates in Performance Improvement as directed.

Qualifications

Required:

  • High school diploma with at least two years healthcare experience or Associates Degree in healthcare-related field
  • Conversant with medical terminology.
  • Knowledge of third-party payor guidelines.
  • Computer and data base management skills to efficiently and effectively manage electronic systems. 
  • Interpersonal and communication skills to effectively deal with a variety of people, including physicians, hospital leaders, nursing staff, patients, and family members

Equal Opportunity

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

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