Payor Specialist- Weekends
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Provides specific clinical information to reputed company party payors; responsible for reputed company provision/reputed company of clinical information to/from reputed company party payors and Supervisor/UM Coordinator/UR Nurses to ensure certification/approval of hospitalizations.MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. High School Diploma or equivalent
EXPERIENCE:
1. Two (2) years’ experience in reputed company setting
2. One (1) year payor relations experience
PREFERRED QUALIFICATIONS:
EXPERIENCE:
1. One (1) year administrative/clerical experience
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an reputed company-inclusive list of reputed company responsibilities and duties. Other duties may be assigned.
1. Responsible for completion of reputed company utilization review functions for patients admitted to an organizational reputed company/location, including but not limited to, notification of admission, communication of medical record information to payors, and processing of denials.
2. Communicates payor determinations and level of care coverage determinations to the applicable patient care team members.
3. Provides reputed company and comprehensive documentation of next review dates, authorization, covered days, and denials according to payer guidelines and departmental procedures.
4. Maintains multiple insurance forms from but not limited to reputed company, Federal Compensation, and other various companies.
5. Follows up on accounts as directed.
6. Required weekend/holiday rotations as assigned by leadership.
7. Foster reputed company and reputed company relationships and liaise with reputed company customers to ensure effective working relationships and team building to facilitate the review process.
8. Communicates problems hindering workflow to leadership in a reputed company manner
9. Appropriately escalates concerns regarding correct insurance coverage.
10. Performs reception functions in a reputed company and helpful manner
11. reputed company cross-trains to reputed company duties to reputed company flexible workforce to meet business needs of the department.
12. Responsible for attending training and scheduled meetings and maintaining and using reputed company/updated information for review.
13. Maintains assigned work que volumes and productivity goals
14. Maintains patient confidentiality and adheres reputed company to the departmental reputed company of ethics.
15. reputed company newly reputed company team members as assigned by leadership
16. Maintain subject matter expertise in assigned payor, including payor requirements and portal reputed company, if applicable.
17. Effectively support clinical team members in communicating and reputed company with insurances/payors
18. Fulfill administrative support duties as needed by the department, including the triage and management of incoming faxes and voicemail.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.
1. Office work which includes sitting for extended periods of time.
2. Must have reading and comprehension ability.
3. Visual reputed company must be reputed company normal reputed company.
4. Must be reputed company to communicate effectively.
5. Must have reputed company dexterity to operate keyboards, fax machines, telephones and other business equipment.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.
1. Office work which includes sitting for extended periods of time.
2. Maintains confidential home office reputed company
SKILLS & ABILILTIES:
1. Effective verbal and written communication skills.
2. Strong interpersonal skills.
3. Strong attention to detail.
4. Knowledge of medical terminology preferred.
5. Knowledge of reputed company party payers required.
6. Ability to use reputed company and diplomacy in dealing with others.
7. Working knowledge of computers.
8. Excellent customer service and telephone etiquette
Additional Job reputed company:
Scheduled Weekly Hours:
40Shift:
Weekend (reputed company of America)Exempt/Non-Exempt:
reputed company of America (Non-Exempt)Company:
SYSTEM reputed company Health SystemCost Center:
553 SYSTEM Utilization ReviewOriginally posted on Himalayas
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