Payor Relations Specialist

Ernest Health, Inc.; Plano (TX); On-site; USD 55,000 - 85,000; Full time

Benefits offered by this job

Medical plans

Health Savings Account (HSA)

Dental

Vision

401K with employer matching

Life insurance

Disability insurance

PTO

Continuing education

Wellness program

Job summary

North Texas Rehabilitation Institute in Plano, TX is seeking a full-time Payor Relations Specialist to manage prior authorizations and payer communications, ensuring timely reimbursement and compliance. The role collaborates with insurers, managed care organizations, and clinical staff to optimize patient care while controlling costs.

RN licensure preferred and Utilization Review experience is valued. This position offers stable benefits and opportunities for professional growth within Ernest

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 to ensure reimbursement for services provided, before, throughout, and after a patient stay.

Skills

RN license

Utilization Review experience

Job description

Overview

North Texas Rehabilitation Institute

We are seeking a full-time 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.