Payor Relations Specialist

Ernest Health, Inc.; Jacksonville (FL); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

PPO and High Deductible Medical Plan

Flexible Spending & Health Savings

Dental and Vision coverage

401K with employer matching

Life insurance

Short- and long-term disability

Employee Assistance Program

Wellness program and incentives

Earned Time Off

Job summary

Ernest Health, Inc. in Jacksonville, FL seeks a Payor Relations Specialist to obtain and maintain service authorizations from third-party payors and collaborate with insurers and clinical staff to ensure patient needs are met.

This full-time role emphasizes maximizing outcomes and reimbursement efficiency. The ideal candidate has a current RN license (preferred) and 2+ years of Utilization Review experience or an equivalent combination of education and experience, with strong organizational and

Qualifications

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

Responsibilities

• Obtain and maintain service authorizations from third-party payors.
• Coordinate with insurers, managed care organizations, and clinical staff to ensure treatment needs are met.
• Maximize patient outcomes and quality of life.

Skills

RN license

Utilization Review

Equivalent education/experience

Job description

Overview

Payor Relations Specialist - Fulltime - Jacksonville, FL

Duval RegionalRehabilitation Hospital at Jacksonville (Jacksonville, FL) is a modern, 48-bed inpatient rehabilitation hospital serving the greater Jacksonville area. The facility is dedicated to helping patients regain independence following serious illness or injury through individualized rehabilitation programs led by experienced clinical teams. Services include physical, occupational, and speech therapy supported by advanced medical oversight. Located in one of Florida’s fastest-growing healthcare markets, the hospital offers a collaborative care environment and serves as a vital step in the continuum of care for patients transitioning from acute hospitalization to home.

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.