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Payor Relations Specialist

2 months ago

Houston Texas, United States Vibra Healthcare Full time

Job Summary:

Vibra Healthcare is seeking a highly skilled Payor Relations Specialist to join our team. As a key member of our clinical team, you will be responsible for obtaining and maintaining service authorizations from third-party payors to ensure reimbursement for services provided.

Key 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, maximizing their overall outcomes and quality of life.
  • 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, and intervene to address and resolve issues/concerns.
  • Ensure 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.

Preferred Qualifications:

  • Assertive and personable with the ability to balance the complex challenge of delivering quality, cost-appropriate, and service-oriented outcomes.
  • Proficient in collecting and retrieving material from medical records.
  • Knowledgeable in utilization review, medical terminology, appropriate levels of care, treatment, modalities, statues, and healthcare delivery models.
  • Strong clinical assessment and process skills, with critical thinking skills demonstrated in all situations.
  • Ability to project a professional image.
  • Knowledge of regulatory standards and compliance requirements.
  • Strong organizational, prioritizing, and analytical skills.
  • Ability to make independent decisions when circumstances warrant.
  • Working knowledge of computer and software applications used in job functions.

About Vibra Healthcare:

Vibra Healthcare is a growing organization dedicated to providing top-quality care to our patients. We are passionate about patient care and consider it a privilege to be able to provide services to patients and their family members. Our world-class team of driven, passionate healthcare professionals are always focused on service excellence and providing top-quality care at the bedside.

Benefits:

  • Medical PPO high and low deductible plans / HSA options as well as HMO options in some markets
  • FREE prescription plans
  • Dental and Vision coverage
  • Life insurance
  • Disability Benefits
  • Employee Assistance Plan
  • Flex Spending plans, 401K matching
  • Additional Critical Illness, Accident, and Hospital plans
  • Company discounts for mobile phone service, electronics, cell phones, clothing, etc
  • Pet Insurance
  • Group legal – provides legal assistance with personal legal matters
  • Tuition and continuing education reimbursement
  • Work life balance