Payor Specialist

WVU Medicine

About The Position

Provides specific clinical information to third party payors; responsible for timely provision/flow of clinical information to/from third party payors and Supervisor/UM Coordinator/UR Nurses to ensure certification/approval of hospitalizations.

Requirements

High School Diploma or equivalent
Two years’ experience in healthcare setting
Payor relations experience
Administrative/clerical experience
Effective verbal and written communication skills.
Strong interpersonal skills.
Strong attention to detail.
Knowledge of third party payers required.
Ability to use tact and diplomacy in dealing with others.
Working knowledge of computers.
Excellent customer service and telephone etiquette

Nice To Haves

Knowledge of medical terminology preferred.

Responsibilities

Responsible for completion of all utilization review functions for patients admitted to an organizational units/location, including but not limited to, notification of admission, communication of medical record information to payors, and processing of denials.
Communicates payor determinations and level of care coverage determinations to the applicable patient care team members.
Provides timely and comprehensive documentation of next review dates, authorization, covered days, and denials according to payer guidelines and departmental procedures.
Maintains multiple insurance forms from but not limited to Medicaid, Federal Compensation, and other various companies.
Follows up on accounts as directed.
Required weekend/holiday rotations as assigned by leadership.
Foster positive and professional relationships and liaise with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
Communicates problems hindering workflow to leadership in a timely manner
Appropriately escalates concerns regarding correct insurance coverage.
Performs reception functions in a positive and helpful manner
Actively cross-trains to perform duties to provide flexible workforce to meet business needs of the department.
Responsible for attending training and scheduled meetings and maintaining and using current/updated information for review.
Maintains assigned work que volumes and productivity goals
Maintains patient confidentiality and adheres strictly to the departmental code of ethics.
Precept newly hired team members as assigned by leadership
Maintain subject matter expertise in assigned payor, including payor requirements and portal access, if applicable.
Effectively support clinical team members in communicating and liaison with insurances/payors
Fulfill administrative support duties as needed by the department, including the triage and management of incoming faxes and voicemail.