Payor Resource Coordinator

Eisenhower Health; Rancho Mirage (CA); On-site; USD 60,000 - 85,000; Full time

Job summary

Eisenhower Health in Rancho Mirage, CA is seeking a reimbursement specialist to ensure timely authorization, notification, and clinical reviews with payers. You will document in EPIC and collaborate with Case Management staff to secure reimbursement for care provided.

You will work with the Clinical Appeal Nurse and department leadership to appeal denials and monitor the status of each appeal with the payer, ensuring clear communication across departments.

Responsibilities

• Works to secure reimbursement for care provided by working closely with Payer, ensuring authorization, notification, and clinical reviews are completed and faxed in a timely manner by the Case Management staff.
• Works closely with Clinical Appeal Nurse and department leadership to ensure all denial are appealed and provides follow up with payer on appeal status.
• Communicates clinical denial and status of appeal to appropriate departments and/or personnel for follow up and documents in EPIC accurately and consistently.

Job description

Job Objective
Works to secure reimbursement for care provided by working closely with Payer, ensuring authorization, notification, and clinical reviews are completed and faxed in a timely manner by the Case Management staff. Works closely with Clinical Appeal Nurse and department leadership to ensure all denial are appealed and provides follow up with payer on appeal status. Communicates clinical denial and status of appeal to appropriate departments and/or personnel for follow up and documents in EPIC accurately and consistently.