Payor Specialist Case Management

Payor Specialist
As Mount Sinai grows, so does our legacy of caring

Located in the heart of Miami Beach, overlooking the breathtaking intracoastal waterway, Mount Sinai Medical Center is dedicated to providing exceptional health care to our diverse community enhanced through innovation, technology, teaching, and research.

Mount Sinai is South Florida's largest private independent not-for-profit hospital with 672 beds, and a tight-knit community of more than 4,000 employees and 500 volunteers

We provide world-class care:

• The only hospital in Miami-Dade to be named one of the nation's 100 Top Hospitals by IBM Watson Health
• A pioneer in innovative medical research in areas such as cardiology, cancer, memory disorders and pulmonary diseases
• The BEST cardiac surgery survival rate in Florida
• A new seven-story Surgical Tower with 154 all-private rooms and patient centered technology promotes an exceptional patient experience

Position Responsibilities:

• Identifies admissions requiring certification for stay and cases requiring continued stay review. Prioritizes in order of necessity (e.g. earliest admissions are more urgent).
• Contacts payers to obtain certification for new admission not already certified/continued stay expiring today utilizing most current clinical review information from Case Manager. Documents per guidelines. Obtains certification for accounts referred by patient Access where clinical information is required. Follows-up with Case Manager if clinical information is delayed or absent.
• Communicates any changes in Case Management review of demographics, to Patient Access, to support appropriate demographic data in STAR system.
• Takes action, based on communicates from Case Manager and/or payor related to the determination of benefits for discharge plan. Contacts Case Manager for any questions or concerns. Initiates payor contact and communicates updated information/authorization to Case Manager and Placement Specialist.
• Supports Placement Specialist to verify details for post-acute placement, transportation and services for patients being transitioned today and tomorrow as appropriate. Identifies any additional information or forms required.
• Enters information into information systems as per department policy and procedure.
  

Qualifications:

• 2 years of healthcare experience, preferably in payor related authorization
• High school diploma required.

Benefits:

We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs. Our robust employee benefits package includes:

• Health benefits
• Life insurance
• Long-term disability coverage
• Healthcare spending accounts
• Retirement plan
• Paid time off
• Tuition reimbursement
• Employee assistance program
• Wellness program
• On-site childcare & Mater School grades K-3
• On-site housing for selected positions and more!