West Virginia Licensed Payor Relations Specialist

Job Summary

Managing pre-certification and prior authorization processes, the full-time remote West Virginia Licensed Payor Relations Specialist will support multiple hospital locations by ensuring timely patient authorizations and developing relationships with payors to enhance referral conversion.

Key responsibilities

• Initiate and complete patient authorizations while maintaining compliance with pre-certification policies
• Collaborate with Business Development and Case Management to ensure effective patient transitions and satisfaction
• Evaluate commercial benefits and manage financial risks associated with patient admissions

Required qualifications

• At least two (2) years of direct experience in third-party reimbursement
• Must be a Registered Nurse (RN) or Licensed Practical Nurse (LPN)
• Experience working with Excel and databases is preferred