Payer Specialist - Pearson Cancer Center/Full-Time Days

Centra Health•Lynchburg, VA

7d•$19 - $27

About The Position

The Payer Specialist performs utilization review and assists case managers with patient accounts, patient type, and timely payer authorizations for initial and continued stays. The role communicates with payers, case managers, patient access, financial services, and clinical disciplines to maintain accurate account information in STAR and support third-party payment. The Payer Specialist also manages appeals for denied cases.

Requirements

High school diploma, GED, or equivalent.
Three years of experience in a healthcare field.

Responsibilities

Complete initial and continued-stay reviews, obtain authorization numbers using information from medical records, and enter authorization numbers and account notes in STAR.
Apply knowledge of Medicare and Medicaid regulations and commercial payer requirements.
Track payer requests, ensure compliance, and communicate requests to appropriate staff to help prevent denials.
Provide feedback on payer guidelines, issues, and trends identified through payer communications and STAR reports; update staff on changes.
Notify physicians, managers, and case managers of chart deficiencies related to insurance requirements.
Review charts for retroactive authorizations and enter authorization numbers and account notes for billing.
Investigate complex payer issues and work to resolve them to prevent costly denials; collaborate with the Revenue Cycle team on denial root causes and resolutions; initiate and follow up on appeals.
Work with the RAC Coordinator to identify RAC issues and risk areas, and instruct the case management department on RAC activity and process adjustments to ensure compliance with federal regulations.
Participate in Revenue Cycle projects, including implementation or installation of new systems and system upgrades.
Serve as a resource for departmental software applications and computer communication issues, and take initiative to research issues.
Maintain the Kronos timekeeping system.
Ensure compliance with Medicaid certification.
Collaborate with physician practices and ancillary departments to provide accurate information.
Respond to account and customer inquiries in a timely and courteous manner.
Serve as a resource to staff, payers, and the organization, and demonstrate flexibility as needs change.
Respond promptly to payer requests for additional information or clarification to mitigate denial risks; seek case manager assistance with questionable accounts.
Assist with staff orientation.