What are the responsibilities and job description for the Payor Liaison | Utilization Review | PRN Days position at UF Health?
Since the doors opened more than 59 years ago, UF Health Leesburg Hospital has continued to build upon its reputation as a leading medical center and the most comprehensive provider of health care services in the region. The hospital offers advanced cardiovascular care, including one of the largest open-heart programs in Florida. The American College of Cardiology has recognized UF Health Leesburg Hospital for its demonstrated expertise and commitment in treating patients with chest pain by awarding a Chest Pain Center Accreditation with Primacy PCI and Resuscitation — its highest and best level of accreditation. The hospital also offers world-class orthopedics, minimally invasive robotic surgery, life-saving emergency care, stroke treatment, labor & delivery, and so much more.
Responsibilities
Under the general supervision of the Director of Utilization Management, the Payor Liaison is responsible for working with insurance providers and hospital teams, in support of effective clinical resource management. The Payor Liaison will serve as a liaison between insurance providers and hospital teams, ensuring inpatient hospitalization admission authorizations are secured initially, concurrently and after hospital discharge. The Payor Liaison will communicate and document hospital approval and denial decisions to appropriate hospital personnel. The Payor Liaison will securely provide/facilitate provision of patient clinical documentation to insurance providers, attesting to patient hospital stays-initially, concurrently and post hospital discharge. The Payor Liaison will provide utilization management/clinical resource management support in accordance with the hospital’s utilization review plan, Federal and State guidelines, and The Joint Commission standards.
Qualifications
- Education
- Associate’s Degree required
- Bachelor’s Degree preferred
- 5 years of experience may be substituted for AS or BS degrees
- Licensure/Certification/Registration
- N/A
- Special Skills/Qualifications/Additional Training/Experience Required
- Must be able to read, write, speak and understand English.
- Two years’ experience performing utilization review, insurance, or provider relations liaison work in a hospital setting, for a third-party payer, or for other review agency or organization
- Knowledge of diagnostic related groups (DRGs), Federal and State guidelines, other payer groups and ICD-10-CM coding preferred
- Must possess strong written and verbal communication skills
- Ability to use computer required