Payor Specialist

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