Payer Communication Specialist

JOB SUMMARY Provides clerical and administrative support to the case management (CM) department to prevent and manage denials. Duties include researching and updating the payer requirements and follow up on pending authorizations and appeals.

DUTIES AND ESSENTIAL FUNCTIONS Responsible for processing incoming mail related to utilization management process. Communicates denial information to revenue integrity department. Submits appeals for technical denials and supports the case manager in appeal cases.

Researches and confirms the payer requirements and educates the CM team on such requirements while keeping those requirements on the shared drive. Maintains all payer portal. Acts as a liaison for the business office for all claim issues as well as all payers and onsite nurses.

Calculates the Medicare Days for patients to ensure proper authorization is obtained when requested by the case manager. Manages payroll and the department schedule. EDUCATION/LICENSE/CERTIFICATION/OTHER REQUIREMENTS Minimum requirement:

High School Diploma or GED.## Must be able to type 35 CWPM. Preferred qualifications: Associate#s Degree One year healthcare related experience WORKING ENVIRONMENT Works indoors in an office/clinic setting The noise level is usually moderate PHYSICAL DEMANDS Constantly required to maintain a stationary position behind a computer.

Frequently required to move about inside the department. Constantly required to communicate telephonically and face to face with colleagues and customers. Constantly required to operate a computer and telephone.

Constantly required to lift and/or move up to 10 pounds. Frequently required to lift and/or move up to 25 pounds. Occasionally required to lift and/or move up to 50 pounds Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, and depth perception