Payor Relations Specialist
1 day ago
Overview
We are seeking a highly skilled Payor Relations Specialist to join our team at Ernest Health. As a key member of our team, you will play a critical role in ensuring reimbursement for services provided to our patients.
Responsibilities
- Obtain and maintain service authorizations from third-party payors to ensure reimbursement for services provided.
- Work directly with insurers, managed care organizations, and clinical staff to ensure the treatment needs of patients are met.
- Coordinate clinically complex patient care across a continuum, ensuring and facilitating the achievement of quality clinical and cost outcomes.
- Negotiate, procure, and coordinate appropriate services and resources needed by patients.
- Intervene to address and resolve issues/concerns, ensuring appropriate sequencing of treatment goals and implementation of a comprehensive discharge plan.
Requirements
- A current, valid, and active license to practice as a Registered Nurse, Licensed Practical Nurse, Occupational Therapist, Physical Therapist, Speech Therapist, MSW, or Licensed Social Worker in the state of employment.
- Current BLS certification from a Vibra-approved vendor.
- Minimum one (1) year of case management experience preferred.
- Minimum of two (2) years recent experience in Utilization Review preferred.
Benefits
At Ernest Health, we offer a comprehensive benefits package, including medical, dental, and vision coverage, life insurance, disability benefits, and a 401(k) matching program. We also offer tuition reimbursement, continuing education opportunities, and a supportive work environment that fosters engagement, diversity, and advocacy.
About Ernest Health
Ernest Health is a growing organization dedicated to providing top-quality care to our patients. Our world-class team of healthcare professionals is passionate about delivering exceptional service and promoting a culture of excellence. We are committed to empowering our employees and supporting their professional growth while leading them on a path to success within our organization.
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