Payor Specialist - Clinical Case Management

Job Summary

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

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.

Atrium Health is one of the nation’s leading healthcare organizations, connecting patients with on-demand care, world-class specialists and the region’s largest primary care network. A recognized leader in healthcare delivery, quality and innovation, our foundation rests on providing clinically excellent and compassionate care.

We’ve been serving our community since 1940, when we opened our doors as Charlotte Memorial Hospital. Since then, our network has grown to include more than 40 hospitals and 900 care locations ranging from doctors’ offices to behavioral health centers to nursing homes.

Our focus: Delivering the highest quality patient care, supporting medical research and education, and joining with partners outside our walls to keep our community healthy.