Payor Relations Specialist

Ernest Health, Inc.; Toledo (OH); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

PPO & HD Medical

FSA/HSA

Dental & Vision

401K

Life insurance

Disability

Job summary

Rehabilitation Hospital of Northwest Ohio in Toledo, Ohio is hiring a Payor Relations Specialist to manage third-party payor authorizations and ensure timely reimbursement for services.

The role partners with insurers and clinical staff to optimize patient outcomes, leveraging knowledge of clinical operations, regulatory standards, and cost of care, while maintaining confidentiality and strong communication.

Qualifications

• Current state RN license preferred.
• Two years recent Utilization Review experience preferred.
• Knowledge of clinical operations, compliance standards, and treatment cost understanding.

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 outcomes.

Skills

RN license

Utilization Review experience

Confidentiality

Data entry

Word processing

Email

Record management

Job description

Overview

Payor Relations Specialist; Toledo, Ohio

Rehabilitation Hospital of Northwest Ohio in Toledo, Ohio is a premier inpatient rehab facility offering comprehensive rehabilitative care to patients in the Toledo metro area and beyond. Our hospital is dedicated to restoring hope and functionality to individuals recovering from strokes, brain and spinal cord injuries, complex orthopedic surgeries, and other serious medical conditions that require intensive therapy. We provide a full continuum of rehabilitation services, including advanced neurological rehab, orthopedic and sports injury rehab, and cardiopulmonary rehab, all administered by a compassionate team of specialists. At Rehabilitation Hospital of Northwest Ohio, each patient benefits from an individualized care plan and one-on-one therapy sessions in our cutting‑edge therapy gym and rehab gardens. Fully accredited and ranked among the nation’s top rehabilitation hospitals, we pride ourselves on delivering efficient, effective care that helps patients achieve remarkable improvements and confidently return to their daily lives.

Toledo, Ohio

Toledo sits on the western shore of Lake Erie and features a mix of cultural attractions, green spaces, and a revitalized waterfront. Known for its zoo, art museum, and welcoming neighborhoods, Toledo combines affordability with quality of life.

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.