- Bluebird Health (Meridian, ID)
- …federal and Joint Commission regulations. Maintains comprehensive working knowledge of payer contracts and ensures that payers are billed according to contract ... independent judgment and demonstrate good communication, negotiation, and public relations skills. Demonstrated capability to accurately manage detailed information.… more
- Children's Mercy KC (Kansas City, MO)
- …pre-bill denial avoidance and denial management. Partners with Revenue Cycle, Payor Relations , HIM and Risk Management in support of utilization management and ... hospital processes, clinical patient care, state and federal regulations and payer requirements to participate and guide leadership of interdisciplinary teams… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** The Payer Relations Specialist is responsible for initiatives to identify and build contractual relationships with payers for direct ... a key member of the Waystar payer relations team, the Payer Relations Specialist will drive new value for Waystar's clients by unlocking new… more
- Arkansas Children's (Little Rock, AR)
- …field of study. **Required Work Experience:** Related Field - 3 years managed care, payer relations , payer contract, or physician or hospital billing ... **Summary:** Monday - Friday, 8:00 am - 5:00 pm - Hybrid The Payer Contract Specialist is responsible for managing payer contracts to ensure alignment with… more
- CommonSpirit Health (Rancho Cordova, CA)
- … Payer Strategy & Relationships (PSR) works closely with Divisional Payers the Payer Relations Manager Divisional Directors National PSR team and the PSR ... the negotiation of terms and conditions for Managed Care payer contracts for facility professional and ancillary entities. Primary...is to ensure the terms and conditions of the payer contract adhere to the CSH Standards and Guidelines… more
- Cardinal Health (Hagatna, GU)
- …entire network of participating health plans + Cultivate and maintain on-going payer relationships and Medicaid enrollments. + Adhere to cyclical renewal, retrieval, ... and updates per profile + Work closely with third party vendors to identify data needs and execute updates when required + Report results and outcomes of network status to management at regular intervals + Respond to third party/managed care requests in a… more
- HonorHealth (AZ)
- …pharmacy department employees are trained on all required functions regarding payer and pharmaceutical contractual requirements (adverse event reporting, data and ... inventory reporting, clinical management). Reaffirms with all specialty pharmacy department personnel, on a regular basis, their obligations regarding the dispensing of prescriptions only in good faith. Participates in network quality improvement initiatives… more
- Johns Hopkins University (Baltimore, MD)
- We are seeking a **_Coding Specialist II_** who will be responsible for all aspects of coding, quality assurance, compliance with Federal payer documentation ... to ensure a smoothly functioning billing operation and good patient relations . This includes coordination of the patients' financial billing responsibilities for… more
- Community Health Systems (Franklin, TN)
- …in care management preferred + 1-2 years of experience in utilization management, payer relations , or hospital revenue cycle preferred **Knowledge, Skills and ... **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to… more
- Johns Hopkins University (Middle River, MD)
- We are seeking an **_AR Revenue Cycle Specialist III_** who will be responsible for the basic collection of unpaid third-party claims and standard appeals, using ... registration based on an understanding of the outpatient registration process. The Specialist will use an understanding of claims submission requirements for payors… more
- Johns Hopkins University (Middle River, MD)
- …registration based on an understanding of the outpatient registration process. The Specialist will use an understanding of claims submission requirements for payors ... resolve standard issues or escalate to a more senior specialist . **Specific Duties & Responsibilities** + Uses A/R follow-up...special billing procedures that may be defined by a payer or contract. + Review and update patient registration… more
- Billings Clinic (Billings, MT)
- …needs for program expansion to Manager. * Works closely with Medical Staff, Payer Relations and Patient Financial Services to coordinate needed pre-certification ... to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Pre-Certification Specialist (Full-time) PRE-ACCESS (ROCKY MOUNTAIN PROFESSIONAL BUILDING) req9331 Shift:… more
- Methodist Health System (Richardson, TX)
- …of America) **Job Description :** Your Job: The Medical Authorization Specialist professional responsible for verification of medical coverage, along with ... * Be engaged and eager to build a winning team * Ability to interpret Payer Clinical Policies in reference to practice procedures. * Contacts Payer (s) in a… more
- Commonwealth Care Alliance (Boston, MA)
- …interpretation, and fee schedule issues. + Collaborate closely with Provider Relations , Contracting, Payment Integrity, Appeals & Grievances, and Configuration teams ... and recommend resolution pathways. + Interpret and apply MassHealth fee schedules, All- Payer Rate Setting regulations, and CMS payment methodologies (eg, DRG, APC,… more
- Omaha Children's Hospital (Omaha, NE)
- …and appropriate reimbursement in accordance with federal, state, and private health payer policies. **Essential Functions** + 1. Review complex surgical reports for ... a timely and accurate professional manner. * Demonstrate and support good relations between Children's Hospital, the contracted providers, and the community. * Make… more
- University of Rochester (Rochester, NY)
- …balance report - - Over $10,000 report - - Claim Edits - - 10% Payer Relations and Escalation Process - Identify and clarify issues that requirement management ... arrangements, and specialized services. Revenue Collection activities focus on an assigned payer billed at the primary level. Schedule 7:30 AM-4 PM Responsibilities… more
- WellSpan Health (York, PA)
- …Commission. Serves as a key liaison among hospitals, ambulatory practices, payer relations and executive leadership. **Duties and Responsibilities** **Essential ... payer enrollment required. **Licenses:** + Certified Provider Credentialing Specialist Upon Hire Preferred or + Certified Professional Medical Services… more
- Corewell Health (Grand Rapids, MI)
- …strategy will be supported by coordinating with Medical Policy and Provider Relations teams to effectively plan and execute program tactics. Manage the vendors ... hospital or physician billing, or equivalent experience with a managed care payer + Experience working with government programs including Medicare, Medicaid and FEHB… more
- LifePoint Health (Las Cruces, NM)
- …collaborates with Credentialing, Care Management, technology platform, and payer representatives as appropriate. *_Responsibilities:_* Collaborate with various ... the assigned providers and practices. Onboarding Education and Training. Payer contract offerings. Strategic network communication. Performance reports and… more
- Ventura County (Ventura, CA)
- …strong Inpatient and Outpatient coding experience and Certified Coding Specialist certification combined with extensive supervisory experience overseeing other ... Coders (Inpatient & Outpatient), coding productivity and collaborate with Clinical Documentation Specialist team; + Provides coding guidance to staff on the most… more
