Payor Relations Specialist - Vibra Healthcare

Overview

COME BUILD YOUR CAREER WITH VIBRA HEALTHCARE!

We are seeking a Payor Relations Specialist to join our team!

Managed Care Experience Required.

Hospital Details

Vibra Hospital of Clear Lake is a Critical Care Hospital providing acute care services to patients recovering from serious illnesses or injuries. Often our patients require additional critical care services for medically complex conditions such as trauma, infectious diseases, wound healing, cardiovascular disease, stroke, amputation and ventilator weaning. As a smaller, specialized hospital, we offer an opportunity to work in a fast-paced and friendly work environment where you really get to know your patients and their families.

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.
Responsibility to coordinate clinically complex patient’s care across a continuum; ensuring and facilitating the achievement of quality clinical and cost outcomes, negotiating, procuring and coordinating appropriate services and resources needed by the patients, and at key points, intervening to address and resolve issues/concerns. Key in ensuring appropriate sequencing of treatment goals and implementation of a comprehensive discharge plan.

Required Skills:

• A current, valid, and active license to practice as a Registered Nurse, Licensed Practical Nurse, Occupational Therapist, Physical Therapist, Speech Therapist, MSW, or Licensed Social Worker in the state of employment required.
• Current BLS certification from a Vibra-approved vendor required.

Additional Qualifications/Skills:

• Minimum one (1) year of case management experience preferred.
• Minimum of two (2) years recent experience in Utilization Review preferred.
• Must be assertive and personable with the ability to balance the complex challenge of delivering quality, cost- appropriate, and service-oriented outcomes..
• Proficient in collecting and retrieving material from medical records.
• Knowledgeable in utilization review, medical terminology, appropriate levels of care, treatment, modalities, statues, and healthcare delivery models.
• Must possess strong clinical assessment and process skills. Critical thinking skills must be demonstrated in all situations. Ability to project a professional image.
• Knowledge of regulatory standards and compliance requirements. Strong organizational, prioritizing and analytical skills.
• Ability to make independent decisions when circumstances warrant.
• Working knowledge of computer and software applications used in job functions. Freedom from illegal use of and effects of use of drugs and alcohol in the workplace.

Benefits

At Vibra Healthcare, employees are our priority. We are passionate about patient care and consider it a privilege to be able to provide services to patients and their family members. Below is a brief summary of our benefits.

• Medical PPO high and low deductible plans / HSA options as well as HMO options in some markets
• FREE prescription plans
• Dental and Vision coverage
• Life insurance
• Disability Benefits
• Employee Assistance Plan
• Flex Spending plans, 401K matching
• Additional Critical Illness, Accident, and Hospital plans
• Company discounts for mobile phone service, electronics, cell phones, clothing, etc
• Pet Insurance
• Group legal – provides legal assistance with personal legal matters
• Tuition and continuing education reimbursement
• Work life balance

At Vibra Healthcare, our patients are family. Healthcare is constantly evolving, our growing organization is devoted to ensuring that each person in our care feels safe. Our world-class team of driven, passionate healthcare professionals are always focused on service excellence and providing top quality care at the bedside. Our culture fosters engagement, diversity and advocacy. Our goal is to empower our employees and support them in their professional growth while leading them on a path to success within our organization.