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The Payor Specialist is responsible for payor notification, and securing authorizations for all admissions systemwide. They receive and answer voicemail and process faxes sent by the payers which includes authorizations, denials and requests for more information. They also act as the resource for the department for all payer information.

ACCOUNTABILITIES

All duties listed below are essential unless noted otherwise

Performs clerical support functions for the UM department. Completes timely initial notification of all inpatient and observation admissions systemwide with per payor contract via phone, fax, and payer portals to request authorization for admission using various WQs assigned in Epic. Submits 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 documents in Epic all payor determinations received by fax or voicemail in a timely manner. Effectively communicates payer requests to UM Nurse using Epic functionality, Teams or Outlook email. Effectively completes authorization follow up via phone or payer portals to secure authorizations for admissions using various WQs assigned in Epic. Compliant with HIPPA and patient confidentiality regulations. Always shows respect and value for our customer and projects an image of professionalism. Assists with training new staff Other duties as assigned.

Education: High school diploma

Skills: Must have access to high speed internet in your home. Must possess strong computer skills as you will be working from home. Must have knowledge of Microsoft Word, Outlook, Adobe and Excel. Previous knowledge of Epic is preferred.

Must be able to input and retrieve information from a computer and operate a phone. Must be able to address multiple priorities in a timely manner. Must be able to understand directions, communicate and respond to inquiries in an accurate and timely manner. Must have excellent interpersonal and communication skills. Must exercise professional behaviors. Must consider the role as part of a multidisciplinary team, with a teamwork approach to patient care. Must exhibit behavior consistent with mission, vision, and values of ProMedica Health System.

PREFERRED QUALIFICATIONS

Skills: Previous knowledge of Epic. Previous knowledge of insurance guidelines, federal regulations.

ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace

Requisition ID: 86963