Payor Specialist

Department:

11215 Behavioral Health Contract Management Group: Charlotte - Utilization Management

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

100% Remote

M-F, business hours

Pay Range:

$21.85 - $32.80

Essential Functions

Communicates clinical information and negotiates with payors to obtain authorization for appropriate level of care and length of stay. Ensures payor and customer satisfaction through effective communication and positive customer service skills at all times.

Provides prompt feedback regarding payor determinations to appropriate staff. Obtains preferred provider and benefit information for home care, DME and post acute services.

Maintains and enters certification information in appropriate information system.

Communicates any change in payor information to Outcomes Manager/Care Coordinator. Documents changes appropriately.

Physical Requirements

Must be able to handle fast paced environment. Must have the ability to communicate clearly in English both verbally and in writing. Must be able to lift a minimum of 10 pounds. Intact hearing and sight with or without assistive devices. This position requires long periods of sitting phone use. Repetitive wrist motion.

Education, Experience and Certifications

High School Diploma or GED required; Associates Degree or Bachelor's Degree preferred. Experience with Third Party Reimbursement or Utilization Management and knowledge of medical terminology preferred.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

Premium pay such as shift, on call, and more based on a teammate's job

Incentive pay for select positions

Opportunity for annual increases based on performance

Benefits and more

Paid Time Off programs

Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability

Flexible Spending Accounts for eligible health care and dependent care expenses

Family benefits such as adoption assistance and paid parental leave

Defined contribution retirement plans with employer match and other financial wellness programs

Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

Provides specific clinical information to third party payors; responsible for timely provision/flow of clinical information to/from third party payor.