Payor Specialist - Atrium Health PRN Days

Overview

Job Summary

Promotes a positive relationship between payor specialist and departmental staff members. Coordinates with Resource Center management to ensure Resource Center staff members possess the knowledge and skill to complete daily assignments efficiently and effectively though collaborative educational efforts.

Essential Functions

• Communicates clinical information and negotiates with payors to obtain authorization for appropriate level of care and length of stay. Documents interactions in STAR information system and Provider Link.
• Provides prompt feedback regarding payor determinations to Care Coordinator/Outcomes Manager, enabling them to evaluate/re-direct the current patient plan of care in order to streamline the delivery of service.
• Obtains preferred provider and benefit information for home care, DME and post acute services based on the clinical needs of the patient.
• Enters and maintains certification information in appropriate information system and educates others as needed.
• Communicates proactively any change in payor information to Outcomes Manager/Care Coordinator and documents changes appropriately. Assists in training payer specialists in account note documentation.
• Identifies concurrent denials by third party payors and notifies Care Coordinator/Outcomes Manager and Resource Center Outcomes Manager for immediate intervention.
• Ensures payor and customer satisfaction through effective communication and positive customer service skills at all times.
• Sends clinical information via telephonic review, manual fax, and Provider Link as indicated.
• Acts as a liaison to share patient-specific insurance and updates to pertinent areas.

Physical Requirements

Must be able to handle fast paced environment. Must have the ability to communicate clearly in English both verbally and in writing. Must be able to lift up to 10 pounds. Intact hearing and sight with or without assistive devices. Prolonged periods of sitting and phone use. Repetitive wrist motion.

Education, Experience and Certifications

High School Diploma or GED required; Bachelor's Degree preferred. 5 years combination experience Third Party Reimbursement or Utilization Management, Payer Specialist. Knowledge of medical terminology required. Excellent written and verbal communication skills required. Strong communication, interpersonal, organizational and problem solving skills required. Demonstrated knowledge and competency in computer applications required.