What are the responsibilities and job description for the Payor Specialist position at UPMC?
The Payor Specialist role offers the opportunity to play a key role in the healthcare revenue cycle process, by obtaining inpatient authorizations from payors and communicating updates and denials to the UPMC patient Care Management team. This role is part of a welcoming, team-centered department and offers great growth potential.
The Payor Specialist works on-site in Harrisburg Monday-Friday and will be required to work occasional weekends (approximately 1 weekend every 3 months). Future department needs may require limited holiday coverage.
Purpose:
Performs a variety of clerical, secretarial and payor related functions.
Responsibilities:
- Assist in notification to payors of admissions/discharges.
- Assist in communicating payor issues and concerns regarding level of care, continue stay, denials and discharge plans to care managers as appropriate and documents interactions in Canopy.
- Support the denial management processes, specifically concurrent and retrospective denials, and appeals.
- Assist in prompt payor feedback to care managers/social workers enabling them to re-evaluate/re-direct the current patient plan of care in order to streamline the delivery of service.
- Participate in yearly continuing education programs to include fire, safety, disaster and Universal Precautions.
- Assist in obtaining payor benefit verification for post-acute services when requested.
- Enter and maintain authorization/certification information in Canopy and Medipac System as it is obtained.
- Effectively support payer call center as it relates to obtaining authorization for the appropriate level of care.
- Support and adhere to the hospital's and the department's policies and procedures, philosophy and mission applying Service Excellence attitudes and behaviors in the process of performing all job responsibilities.
