LPN Payor Specialist

Extrapolates clinical information from the clinical record to prepare a review for payers during the certification process. Collaborates with Care Managers (CM) to provide specific clinical information to third party payors; responsible for timely provision/flow of clinical information to/from third party payor and CM to ensure certification/approval of inpatient and post discharge services. Collaborates with the Medical Director (MDR) regarding denials and appeals. Ensures that referrals are made to appropriate community resources in a timely manner. Investigates and resolves reimbursement obstacles as identified on the financial reports for assigned payors
Qualifications
High school diploma or GED required. LPN certification required. Two to three years of clinical or physicians office required. One to two years experience in precertification within a health system or managed care organization preferred. Computer literacy and knowledge of medical terminology required.
Licenses/Certifications: (indicate if required or preferred)
Requires minimum LPN / PA licensure
Physical Demand Analysis:
Physical: Sitting, Standing, Lifting, and Walking, Agility, Dexterity
Visual Requirements: Near Vision, Depth Perception, Color Vision, Extensive exposure to VDT's (Video Display Terminal)
Hearing Requirements: Ability to hear normal conversation, Telephone communication, Hear low voice volumes, whispers
Working Conditions: Office Setting
Physical Demands Analysis: Sedentary - Little shifting of position, primarily sitting; lifting 10lbs maximu
Conditions of Employment
Since this position will require the selected candidate to engage in regular contact with children in the form of care, guidance, supervision or training, you will be required to meet the requirements of the Child Protective Services Act, including the Pennsylvania State Police criminal background check, the Pennsylvania Department of Welfare child abuse criminal background clearance, and an FBI finger print based federal criminal records check. The selected candidate will not be allowed to commence working until all three (3) are completed satisfactorily.
Closing Statement
Einstein Healthcare Network is a private, not for profit organization with several major facilities and many outpatient centers. Our primary mission is to provide compassionate, high quality healthcare to the greater Philadelphia region.