Payor Specialist

Job Summary

A company is looking for a Payor Specialist to work remotely across various time zones.

Key Responsibilities

• Verify insurance coverage and submit authorization requests while maintaining communication with insurance companies
• Coordinate with the Case Management Team to prioritize daily activities and ensure timely payor determinations
• Document authorization outcomes and communicate necessary follow-up steps to the Case Management Team

Required Qualifications, Training, and Education

• Experience with payors and knowledge of Clinical Guidelines or Medical Policy is preferred
• Conversant with medical terminology and third-party payor guidelines, including Medicare/Medicaid
• High School Diploma with at least 5 years of healthcare experience or an Associate's Degree with at least 3 years of experience
• Strong expertise in navigating complex insurance frameworks and payment negotiations
• Computer and database management skills to manage proprietary electronic systems effectively