Payor Specialist

Job Summary

A company is looking for a Payor Specialist to manage clinical information flow to third-party payors for hospitalizations.

Key Responsibilities

• Complete utilization review functions, including communication of medical record information to payors and processing denials
• Communicate payor determinations to the patient care team and provide documentation according to payer guidelines
• Maintain insurance forms and follow up on accounts as directed, while fostering professional relationships with internal and external customers

Required Qualifications

• High School Diploma or equivalent
• Two years of experience in a healthcare setting
• Experience in payor relations
• Administrative or clerical experience
• Ability to maintain patient confidentiality and adhere to departmental ethics