Lead Payor Specialist
Core
Leads the Quality Utilization team to obtain timely initial and continued stay authorizations from payors for acute care inpatients.
Role type
Senior IC healthcare utilization specialist (payor relations)
Builds
Pre-authorization and pre-certification determinations for acute care inpatients
Domain
Healthcare administration / Insurance utilization
Required skills
Medical terminology, Third-party payor guidelines, Medicare/Medicaid guidelines, Database management, Training development, Workflow design
Preferred skills
Master's degree in healthcare, 7+ years experience, Professional certifications
Technologies
Careport, Epic
Responsibilities
Leads and trains Payor Specialists; Reviews escalated cases for accuracy; Coordinates onsite payor review activities; Manages denial and peer review documentation; Adjusts daily staff assignments based on patient volume.
Seniority
Senior, hands-on IC with team leadership