Care Management Payor Liaison for Authorization & Review

Luminis Health; Annapolis (MD); On-site; USD 2,659,000 - 3,987,000; Full time

Job summary

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

The role involves reviewing Case Manager worklists, communicating medical record information to payors for authorizations, and ensuring timely responses and accurate documentation. Experience with billing, Medicare, Blue Cross, and Medicaid is preferred.

Qualifications

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

Responsibilities

• Reviews each Case Manager's daily work list to identify clinical reviews due to payor.
• Communicates medical record information to payors to obtain authorization for admission, continued stay or levels of care.
• Verifies payor responses and follows up; notifies Case Manager and leadership of delays or discrepancies.
• Keeps Case Manager informed of determinations and notifies if more information is needed.
• Obtains insurance authorization and submits clinical information to Payors and Care Management nurses; completes Medical Assistance 3808s.

Education

High school diploma or equivalent

Job description

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

The role involves reviewing Case Manager worklists, communicating medical record information to payors for authorizations, and ensuring timely responses and accurate documentation. Experience with billing, Medicare, Blue Cross, and Medicaid is preferred.