Payor Specialist

3 weeks ago

Toledo, Ohio, United States ProMedica Full time
Job Title: Payor Specialist

The Payor Specialist is a key member of the Utilization Management team at ProMedica, responsible for ensuring seamless communication with payors to secure authorizations for patient admissions.

Key Responsibilities:
  • Perform timely initial notification of all inpatient and observation admissions systemwide with per payor contract via phone, fax, and payer portals.
  • Submit clinical information per payor contract via payer portals, fax, or Secure Outlook email to obtain authorization for appropriate level of care and length of stay as needed.
  • Effectively document in Epic all payor determinations received by fax or voicemail in a timely manner.
  • Effectively communicate payer requests to UM Nurse using Epic functionality, Teams, or Outlook email.
  • Complete authorization follow-up via phone or payer portals to secure authorizations for admissions using various WQs assigned in Epic.
Requirements:
  • High school diploma
  • Strong computer skills, including Microsoft Word, Outlook, Adobe, and Excel
  • Previous knowledge of Epic is preferred
  • Ability to input and retrieve information from a computer and operate a phone
  • Excellent interpersonal and communication skills
Preferred Qualifications:
  • Previous knowledge of insurance guidelines and federal regulations

ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. We are committed to providing high-quality patient care and excellent customer service. If you are a motivated and detail-oriented individual who is passionate about healthcare, we encourage you to apply for this exciting opportunity.

  • Payor Specialist

    4 weeks ago

    Toledo, Ohio, United States ProMedica Full time

    Job Title: Payor SpecialistThe Payor Specialist plays a critical role in ensuring seamless communication between ProMedica and payors, facilitating timely authorizations and notifications for patient admissions. This position requires strong organizational skills, attention to detail, and effective communication to ensure compliance with payor contracts and...

  • Managed Care Contract Specialist

    4 days ago

    Toledo, Ohio, United States ProMedica Health System Full time

    Job Title: Managed Care Contract SpecialistProMedica Health System is seeking a highly skilled Managed Care Contract Specialist to join our team. As a key member of our Managed Care team, you will be responsible for developing and implementing managed care strategies and relationships designed to maintain and grow our network of hospitals, primary care and...

  • CBO Specialist II

    3 weeks ago

    Toledo, Ohio, United States ProMedica Full time

    Job Title: CBO Specialist IIProMedica is seeking a highly skilled CBO Specialist II to join our team. As a key member of our healthcare team, you will be responsible for facilitating accurate professional provider credentialing, coding, billing, posting, and collection for ProMedica Physicians and all other supported entities.Key Responsibilities:Accurate...

  • Professional Credentialed Specialist

    2 months ago

    Toledo, Ohio, United States ProMedica Full time

    Job SummaryWe are seeking a highly skilled and detail-oriented Professional Credentialed Specialist to join our team at ProMedica. As a key member of our organization, you will be responsible for ensuring accurate and timely credentialing, coding, billing, and collection for our physicians and supported entities.Key ResponsibilitiesAccurate and timely...

  • CBO Specialist II

    3 days ago

    Toledo, Ohio, United States ProMedica Full time

    Job SummaryWe are seeking a highly skilled and detail-oriented CBO Specialist II to join our team at ProMedica. As a key member of our revenue cycle team, you will be responsible for facilitating accurate and timely credentialing, coding, billing, and collection for our physicians and supported entities.Key ResponsibilitiesAccurately and timely credentialing...

  • Fatherhood Peer Specialist

    2 days ago

    Toledo, Ohio, United States Zepf Full time

    Job Title: Fatherhood Peer SpecialistAt Zepf, we are seeking a highly motivated and compassionate Fatherhood Peer Specialist to join our team. As a key member of our organization, you will play a vital role in supporting fathers in our program and ensuring that all necessary information is collected and shared with our data manager.Job Summary:The Fatherhood...

  • Fatherhood Peer Specialist

    2 days ago

    Toledo, Ohio, United States Zepf Full time

    Job Title: Fatherhood Peer SpecialistAt Zepf, we are seeking a highly motivated and compassionate Fatherhood Peer Specialist to join our team. As a key member of our team, you will play a vital role in supporting fathers in our program, ensuring that all necessary information is collected and shared with our data manager.Job SummaryThe Fatherhood Peer...

  • Claims Examiner II/III

    3 weeks ago

    Toledo, Ohio, United States Innovative Management Systems Incorporated Full time

    Job Title: Claims Examiner II/IIIInnovative Management Systems Incorporated is seeking a highly skilled Claims Examiner II/III to join our team. As a Claims Examiner II/III, you will be responsible for accurately reviewing, researching, and analyzing professional claims for a managed service organization (MSO).Key Responsibilities:Identify authorizations and...