Payor Specialist

4 weeks ago

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

The 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 regulations.

Key Responsibilities:
  1. Perform clerical support functions for the Utilization Management department, ensuring timely and accurate completion of tasks.
  2. Complete initial notification of all inpatient and observation admissions systemwide, utilizing various Workqueues (WQs) assigned in Epic to request authorization for admission.
  3. 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.
  4. Effectively document in Epic all payor determinations received by fax or voicemail in a timely manner.
  5. Communicate payer requests to UM Nurse using Epic functionality, Teams, or Outlook email.
  6. Complete authorization follow-up via phone or payer portals to secure authorizations for admissions using various WQs assigned in Epic.
  7. Comply with HIPAA and patient confidentiality regulations, maintaining the highest level of professionalism and respect for customers.
  8. Assist with training new staff members and perform other duties as assigned.
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
  • Ability to address multiple priorities in a timely manner
Preferred Qualifications:
  • Previous knowledge of Epic
  • Previous knowledge of insurance guidelines and federal regulations

ProMedica is an equal opportunity employer and welcomes applications from diverse candidates. If you have a disability and require an accommodation to apply, please contact us.

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