Payor Relations Specialist

Ernest Health, Inc.; Denver, Northern (CO, KY); On-site; USD 54,000 - 68,000; Full time

Benefits offered by this job

Medical plans

HSA/FSAs

Dental & Vision

401K match

Life insurance

Disability

Job summary

Ernest Health, Inc. is seeking a Payor Relations Specialist in Denver, CO, to manage authorizations with third‑party payors and support patient care financials. The role collaborates with insurers, MCOs, and clinical staff to ensure timely reimbursement and optimal patient outcomes.

We offer comprehensive benefits and growth opportunities through continuing education and wellness programs as part of our employee experience.

Qualifications

• 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.
• They will work directly with insurers, managed care organizations, and clinical staff to ensure the treatment needs of the patients are met, maximizing outcomes and quality of life.

Skills

RN license

Utilization Review

Education/Experience mix

Job description

Overview

Payor Relations Specialist - Full Time - Denver, Colorado

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

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.

Posted Total Compensation

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including, but not limited to, skill sets, experience, education and training, licensure and certifications, and other business and organizational needs. It’s not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $

Minimum Salary

USD $39.00/Hr.

Maximum Salary

USD $49.00/Hr.