Payor Specialist - Medical Device, Third-Party Payors - Healthcare

The Payor Specialist is responsible for verifying and reverifying insurance coverage and eligibility, submitting and following up on authorization requests, and maintaining follow-up communication with insurance companies. More specifically, this role verifies patient insurance benefits for specific procedure coverage, updates eligibility information, submits and follows up on authorizations and LOA/SCA requests, and requests network or payment related exceptions. Core Duties/Responsibilities: Works directly in alignment with Case Management Team to coordinate efforts and prioritize daily activities to meet deadlines. Completes insurance benefits verification and reverification to confirm active coverage, benefit details, payor requirements, and applicable patient responsibility. Updates eligibility information accurately and timely based on payor verification and reverification findings. Submits authorization requests when required and performs timely follow-up through final payor determination. Submits Letters of Agreement (LOA) and Single Case Agreements (SCA) when required and performs timely follow-up through rate negotiation, execution, or final payor determination. Obtains timely payor determinations regarding authorizations, LOA/SCA requests, network exceptions, and other payment-related needs, and accurately records and conveys determinations to the Payor Specialist Manager/Case Management Team Tracks and assures compliance with payor requests for information and com