Care Management Payor Liaison & Authorization Specialist

Luminis-Health; Annapolis (MD); On-site; USD 27,000 - 40,000; Full time

Job summary

Luminis Health seeks a dedicated professional to facilitate the exchange of clinical information and authorization between the hospital and third party payors, supporting the utilization review process.

Responsibilities include coordinating payor authorizations for admissions and levels of care, and ensuring timely communication with Case Management and care teams. Requires a high school diploma and at least one year of billing/Medicare/Medicaid experience.

Qualifications

• High school diploma or equivalent.
• One year of work experience to include billing/collection experience and/or experience with Medicare, Blue Cross and Medicaid.

Responsibilities

• Reviews each Case Managers daily work list to identify clinical reviews due to the payor that day; reports trends in missed timely reviews to Care Management leadership.
• Communicates medical record clinical information telephonically, via fax, or electronically to payors to obtain authorization for admission, continued stay or levels of care, and documents in the medical record.
• Verifies payor response; contacts payor if no response and initiates action; communicates with Case Manager, Care Management leadership, Physicians or Physician Advisors when concerns arise.
• Keeps Case Manager informed of determinations and notifies promptly if additional information is requested or denial is anticipated.
• Obtains insurance authorization and submits timely clinical information and feedback to Payors and Care Management nurses; completes Medical Assistance 3808s.

Skills

Billing & Collections

Medicare/Medicaid knowledge

Education

High school diploma or equivalent

Job description

Luminis Health seeks a dedicated professional to facilitate the exchange of clinical information and authorization between the hospital and third party payors, supporting the utilization review process.

Responsibilities include coordinating payor authorizations for admissions and levels of care, and ensuring timely communication with Case Management and care teams. Requires a high school diploma and at least one year of billing/Medicare/Medicaid experience.