Payor Relations Specialist

Ernest Health, Inc.; Bloomington (IN); On-site; USD 60,000 - 75,000; Full time

Benefits offered by this job

401K with employer matching

Life insurance

Short- and long term disability

Dental and Vision coverage

PPO and HDHP options

FSA / HSA options

Job summary

Bloomington Regional Rehabilitation Hospital in Bloomington, Indiana, seeks a Payor Relations Specialist (Clinical) to secure and maintain payer authorizations, collaborating with insurers and clinical staff to optimize patient outcomes and reimbursement.

The role emphasizes clinical operations knowledge, regulatory compliance, and strong communication, confidentiality, and organizational skills within Ernest Health’s network.

Qualifications

• Current state RN license preferred.
• Two years' recent Utilization Review experience preferred.
• Equivalent education and experience may substitute.

Responsibilities

• Obtain and maintain service authorizations from third-party payors to ensure reimbursement for services provided, before, throughout, and after a patient stay. They will work directly with insurers, managed care organizations, and clinical staff to ensure the treatment needs of the patients are met, maximizing their overall outcomes and quality of life.

Skills

Utilization Review

Clinical operations

Compliance standards

Communication skills

Time management

Data entry

Teamwork

Infection control

Confidentiality

Education

RN license

Job description

Payor Relations Specialist ( Clinical) - Full Time - Bloomington, Indiana

Bloomington Regional Rehabilitation Hospital in Bloomington, Indiana, is a cutting-edge inpatient rehab hospital focused on helping patients throughout Southern Indiana reclaim their lives after serious injuries or illnesses. We provide highly individualized rehabilitation programs for a wide range of conditions, including stroke recovery, traumatic brain injury, spinal cord injury, complex orthopedic recovery, and more. Our team of caring professionals – from rehab physicians and nurses to physical, occupational, and speech therapists – works hand in hand with patients and their families to set goals and celebrate progress, fostering a motivating environment. Bloomington Regional features the latest rehabilitation technology and therapy techniques, as well as amenities such as a therapeutic gym and an outdoor mobility track, to enhance the rehabilitation experience. Accredited and part of Ernest Health’s nationally recognized network, our hospital is known for its welcoming atmosphere and excellent patient outcomes, making it an ideal place for dedicated caregivers to make a difference and for patients to achieve their fullest recovery potential.

Why You’ll Love Living in Bloomington, Indiana

Bloomington offers the perfect blend of natural beauty, cultural vibrancy, and small-city charm. Home to Indiana University, the city boasts a lively arts scene, diverse dining options, and spirited collegiate events. Outdoor enthusiasts will love the nearby Hoosier National Forest, scenic lakes, and miles of hiking and biking trails. With a lower-than-average cost of living and a strong sense of community, Bloomington is an ideal place to live, work, and thrive.

We are seeking a Payor Relations Specialist to join our team of passionate patient caregivers!

As a participating hospital of Ernest Health, we offer robust recognition, wellness, and retention programs. These programs focus to enhance the employees’ work experience, recognize, and celebrate achievements. We also encourage employees to share their work experience through “My Ernest Journey” and through our Engagement Survey, where our approach is “You Spoke, We Listened”. These platforms provide additional avenues for employees to give feedback about their work experience and share what is important to them.

Our hospital offers comprehensive benefits, designed to support your health and financial well-being.

Benefits:

• PPO and High Deductible Medical Plan options
• Flexible Spending and Health Savings Account options available
• Dental and Vision coverage
• 401K with employer matching
• Life insurance
• Short-and-long term disability

Wellness & Work Life Balance:

• Employee Assistance Program
• Wellness Program with quarterly wellness challenges with participation incentives
• Earned Time Off - start accruing vacation time on start date

Professional Growth:

• Continuing education opportunities and reimbursement

Qualifications

Required Skills:

• Current state RN license preferred.
• Two years recent experience in Utilization Review preferred
• OR any equivalent combination of education and experience.

Additional Qualifications/Skills:

• Knowledge of clinical operations and procedures.
• Knowledge of the compliance and regulatory standards governing health plans and patient care.
• Demonstrates an understanding of treatment costs and financial support as they relate to quality and efficiency.
• Demonstrates general computer skills including: data entry, word processing, email, and record management.
• Effective organizational and time management skills.
• Effective written and verbal communication skills.
• Ability to maintain proper levels of confidentiality.
• Ability to work closely and professionally with others.
• Ability to maintain quality, safety, and/or infection control standards.

Responsibilities

The Payor Relations Specialist is responsible for obtaining and maintaining service authorizations from third-party payors to ensure reimbursement for services provided, before, throughout, and after a patient stay. They will work directly with insurers, managed care organizations, and clinical staff to ensure the treatment needs of the patients are met, maximizing their overall outcomes and quality of life.