Payor Relations Specialist

Ernest Health•Plano, TX

About The Position

North Texas Rehabilitation Institute is seeking a full-time Payor Relations Specialist to join its patient-care team. The role obtains and maintains service authorizations from third-party payors to support reimbursement for services provided before, during, and after a patient stay. The specialist works directly with insurers, managed care organizations, and clinical staff to help ensure patients’ treatment needs are met and to maximize outcomes and quality of life. The position calls for knowledge of clinical operations and procedures, health-plan and patient-care compliance and regulatory standards, and how treatment costs and financial support relate to quality and efficiency. The specialist also uses general computer skills and applies strong organizational, communication, confidentiality, and teamwork skills while maintaining quality, safety, and infection-control standards.

Requirements

Current state RN license preferred.
Two years of recent experience in Utilization Review preferred, or an equivalent combination of education and experience.
Knowledge of clinical operations and procedures.
Knowledge of compliance and regulatory standards governing health plans and patient care.
Understanding of treatment costs and financial support as they relate to quality and efficiency.
General computer skills, including data entry, word processing, email, and record management.
Effective organizational and time-management skills.
Effective written and verbal communication skills.
Ability to maintain proper levels of confidentiality.
Ability to work closely and professionally with others.
Ability to maintain quality, safety, and/or infection-control standards.

Nice To Haves

Current state RN license.
Two years of recent experience in Utilization Review.

Responsibilities

Obtain and maintain service authorizations from third-party payors to ensure reimbursement for services provided before, throughout, and after a patient stay.
Work directly with insurers, managed care organizations, and clinical staff to ensure patients’ treatment needs are met.
Help maximize patients’ overall outcomes and quality of life.

Benefits

PPO and High Deductible Medical Plan options
Flexible Spending and Health Savings Account options
Dental and vision coverage
401(k) with employer matching
Life insurance
Short- and long-term disability
Employee Assistance Program
Wellness Program with quarterly wellness challenges and participation incentives
Earned Time Off, accruing from the start date
Continuing education opportunities and reimbursement
Recognition, wellness, and retention programs