Payor Specialist - LOA, SCA, Third-Party Payors - Healthcare

This is a Fully Remote Job About Our Client:This organization operates within the healthcare sector, focusing on navigating complex insurance systems to support patient care. It addresses challenges related to insurance coverage verification, authorization processing, and payment negotiations, aiming to improve access and financial coordination for patients requiring medical treatments. The organization values collaboration, dedication, and a mission-driven culture focused on improving patient outcomes and supporting healthcare providers. About the Opportunity:The PAYOR SPECIALIST role is essential for ensuring accurate verification and reverification of insurance coverage and eligibility. This position manages authorization requests and maintains communication with insurance companies to facilitate timely approvals. The role contributes to the organization by coordinating with case management to optimize patient access to medical services and support financial processes related to insurance reimbursements. Responsibilities:Coordinate daily activities with the Case Management Team to meet deadlines.Verify and reverify patient insurance benefits and eligibility details.Update eligibility information promptly and accurately.Submit authorization requests and follow up to obtain final determinations.Submit and follow up on Letters of Agreement and Single Case Agreements.Obtain payor decisions related to authorizations, exceptions, and payment issues.Track and ensure compliance with payor information requests.Document and communicate outcomes and next steps to management and case teams.Address out-of-network challenges and work to improve network status.Provide feedback on payor guidelines and issues encountered.Maintain effective communication to ensure payor and customer satisfaction.Proactively follow up on pending payor correspondence.Interpret payor documentation for internal teams and patients.Escalate authorization and agreement reviews as needed to meet scheduling requirements.Collaborate across management and program teams.Perform additional duties as assigned. Requirements:Strong organizational skills and attention to detail.Ability to stay calm and objective under stress.Quick learner with aptitude for innovative tools and methods.Self-accountable for compliance with policies and procedures.Willingness to seek guidance when uncertain.Makes routine decisions with support.Understands key business drivers relevant to the role.Maintains focus despite obstacles.Supports multiple programs and treatment specialties.Manages tasks independently.Knowledge of insurance contracts and reimbursement methods.Ability to negotiate payments within rate parameters.Expertise in complex insurance frameworks including dual coverage and tiered benefits.Preferred experience with payers and clinical guidelines or medical policy.Familiarity with medical terminology.Knowledge of third-party payor and Medicare/Medicaid guidelines.Proficient with computer and database systems.Strong interpersonal and communication skills.High school diploma with five years healthcare experience or Associate's Degree with three to four years experience. Pay Range and Compensation Package:The pay range and compensation package for this role will be determined based on the candidate's experience, skills, and other relevant factors. Benefits & Perks:Remote work from home environment.Flexible working hours to support activities across multiple time zones. Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.