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Payer Specialist

Company: McLaren Northern Michigan
Location: Port Huron
Posted on: June 6, 2021

Job Description:

Position Summary: Supports the Mission, Vision and Values of the Hospital. Facilitates timely communications with third-party payors for patient re-certification to ensure appropriate reimbursement across the continuum. Establishes and maintains ongoing communication with healthcare team regarding concurrent care activities and denial management. Coordinates and communicates denials and appeals across the system. Provides patient-specific care information to third-party payors as needed. Provides initial inpatient diagnoses code using the ICD-10 and CPT coding system.

Essential Functions and Responsibilities:

  1. Provides patients and Hospital staff with information regarding requirements and constraints or

third-party payers and private review programs.

  1. Maintains a commitment to professional growth and competency.
  2. Performs other related duties as required and directed.

Knowledge, Skills, and Abilities:

  • DRG knowledge
  • Adept at data entry & inquiry
  • Excellent communications skills
  • Highly organized
  • Knowledge of interqual criteria

Qualifications :


  • Associates degree in Health Information Systems, LPN or equivalent
  • Two (2) years of experience in coding, utilization management, reimbursement or clinical experience with diagnosis and treatment plans

Keywords: McLaren Northern Michigan, Warren , Payer Specialist, Other , Port Huron, Michigan

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