PAYOR SPECIALIST - COORDINATION OF CARE
Full Time
Fayetteville, NC 28304
Posted
Job description
Work Type: FULL TIME
Work Schedule: DAYS
Location: CAPE FEAR VALLEY MEDICAL CENTER
Position Summary:
Works collaboratively with Case Management (CM) Leadership, Acute Care Nurse Navigator and Medical Social Work Case Managers and Utilization Management (UM) staff in the CM department to support maximum reimbursement for CFVHS. Ensures timely provision and flow of clinical information to and from third party payors and CM to support certification/approval of inpatient days and post discharge services. Communicates clinical reviews and refers payor questions to appropriate CM. Collaborates with Patient Financial Services, Administration, Physicians and Financial Counselors to ensure appropriate reimbursement from third party, private and government payors, for medical services provided in acute care setting.
Knowledge, Skills, and Abilities:
Completed medical terminology course. 3 to 4 years’ experience in managed care. Managed care claims/reimbursement or other healthcare field preferred. Knowledge of third party payor requirements including managed care, reimbursement and utilization review. Excellent computer and data entry skills (Microsoft Word/Excel required). Demonstrates excellent verbal and written communication skills. Able to prioritize and process multiple tasks, responsibilities and work projects, demonstrating strong organizational and time management skills. Demonstrated ability to analyze related information, plan effective actions and follow through reliably to meet expectations. Functions independently and as team member. Strong customer service orientation. Knowledge of English grammar, punctuation and spelling.
Required Education, Licenses, and Certifications:
- High School Diploma or GED
Preferred Education, Licenses, and Certifications:
- Associate's Degree
Business or Finance
Some light carrying and lifting may be required. Occasional walking may be required to access all areas of the Medical Center. Ability to effectively communicate orally to patients, family members, personnel, and physicians. Near visual acuity to proofread hand or typewritten materials. Manual ability to use telephones and computer keyboard. Position involves sitting for extended periods of time performing data entry into a computer.
About Cape Fear Valley Health System
For exceptional healthcare come to Cape Fear Valley Health - where caring employees provide exceptional healthcare to all our patients. At Cape Fear Valley Health, our goal is to improve the quality of every life we touch. To achieve that, our doctors, nurses and staff are committed to excellence in every aspect of the healthcare process. Our values of patient-centeredness, integrity, innovation, teamwork, diversity, and accountability help us create a better experience for every patient, every time. At Cape Fear Valley, our employees and physicians proudly serve a seven-county region of southeastern North Carolina, including Fayetteville, Fort Bragg, Hope Mills, Raeford, Lumberton, Elizabethtown, Clinton, Lillington, Dunn and beyond. Our medical facilities include Cape Fear Valley Medical Center, Highsmith-Rainey Specialty Hospital, Cape Fear Valley Rehabilitation Center, Behavioral Health Care, Bladen County Hospital, Hoke Hospital, Central Harnett Hospital, Betsy Johnson Hospital, as well as several medical offices and specialty clinics spread throughout the Cape Fear region. Since 2017, we have had a graduate medical education program that is home to more than 180 residents and fellows who participate in nine areas of concentration, including Internal medicine, emergency medicine, OB/GYN, general surgery, transitional year, psychiatry, podiatry, cardiology, and child adolescent psychiatry.
Screening Requirements: Drug Screen, Background Check, License and Employment reference verification.
Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity
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