Rehabilitation Authorization and Appeals Specialist PRN

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

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

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:

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.