Payer Specialist- Cancer Center- FT/Days

3 days ago


Lynchburg, Virginia, United States Centra Medical Group Full time

The Payer Specialist is responsible for preforming duties of utilization review assisting case managers with patient accounts, patient type, and timely payer authorizations for initial and continued stay. This includes effective communication with payers, case managers, patient access, financial services and a variety of clinical disciplines to capture and maintain accurate account information in STAR and to ensure 3rd party payment. The Payer Specialist is also responsible for managing appeals for denied cases.

Required Education: High School Diploma / GED

Required Experience: Three (3) years of experience in a healthcare field

Preferred Certifications and Licensures: License for Practical Nurse. Medical Office Assistant Certification

Completes initial/stay reviews/obtains authorization # by obtaining information from the medical record to payer. Puts authorization numbers/account notes in STAR

Demonstrates knowledge of Medicare/Medicaid regulations/various commercial payer requirements

Tracks/assures compliance with payer requests/communicates requests to appropriate staff to prevent denials

Provides feedback for payer guidelines, issues, and trends discovered in communications w/payers/STAR reports. Update staff of changes

Appropriately notifies physicians/manager/case manager of chart deficiencies re: insurance requirements

Reviews charts for retroactive authorizations. Enters numbers/ account notes for billing

Investigates complex payer issues working to resolve preventing costly denials. Works with Revenue Cycle team on root causes of denials/resolve. Initiates appeals of denied cases w/follow up

Works w/RAC Coordinator to identify RAC issues/risk areas. Instructs case management department in RAC activity/adjustments to processes to ensure compliance w/federal regulations

Participates in other Revenue Cycle projects i.e. implementation/installation of new systems/ system upgrades

Resource for software applications/computer communication issues/concerns for department. Takes initiative to research issues

Maintains Kronos timekeeping system

Ensures compliance w/Medicaid certification

Collaborates with physician practices/ancillary departments with accurate info

Responds to inquiries regarding accounts/customers in a timely, courteous manner

Serves as a resource to staff, payers, w/organization. Demonstrates flexibility to changing needs

Responds to payers' requests for more information/clarification promptly thereby mitigating risks of denials. Seeks case manager assistance in questionable accounts

Assists with orientation of staff



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