Payor Specialist-Full Time-Days

Facility

Cape Fear Valley Medical Center

Location

Fayetteville, North Carolina

Department

Coordination of Care

Job Family

Clerical

Work Shift

Days (United States of America)

Summary

Works collaboratively with Case Management (CM) Leadership, Acute Care Nurse Navigator and Medical Social Work Case Managers and Utilization Management (UM) staff in the CM department to support maximum reimbursement for CFVHS. Ensures timely provision and flow of clinical information to and from third party payors and CM to support certification / approval of inpatient days and post discharge services. Communicates clinical reviews and refers payor questions to appropriate CM. Collaborates with Patient Financial Services, Administration, Physicians and Financial Counselors to ensure appropriate reimbursement from third party, private and government payors, for medical services provided in acute care setting. Completed medical terminology course. 3 to 4 years' experience in managed care. Managed care claims / reimbursement or other healthcare field preferred. Knowledge of third party payor requirements including managed care, reimbursement and utilization review. Excellent computer and data entry skills (Microsoft Word / Excel required). Demonstrates excellent verbal and written communication skills. Able to prioritize and process multiple tasks, responsibilities and work projects, demonstrating strong organizational and time management skills. Demonstrated ability to analyze related information, plan effective actions and follow through reliably to meet expectations. Functions independently and as team member. Strong customer service orientation. Knowledge of English grammar, punctuation and spelling. Some light carrying and lifting may be required. Occasional walking may be required to access all areas of the Medical Center. Ability to effectively communicate orally to patients, family members, personnel, and physicians. Near visual acuity to proofread hand or typewritten materials. Manual ability to use telephones and computer keyboard. Position involves sitting for extended periods of time performing data entry into a computer.

Required Licenses and Certifications

Cape Fear Valley Health System is an Equal Opportunity Employer M / F / Disability / Veteran / Sexual Orientation / Gender Identity