• Clm Resltion Rep IV, Hosp/Prv

    University of Rochester (Rochester, NY)
    …global transplant payments and initiates transfer of dollars to each provider. 10% Payer Relations + Identifies need for in-person meetings and phone conferences ... staff and outside agencies regarding contractual obligations. Assures on-going positive relations and support of highly visible unique contracts and arrangements.… more
    University of Rochester (08/07/25)
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  • Revenue Cycle Coordinator IV

    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
    University of Rochester (08/07/25)
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  • Director of Managed Care Contracting

    Stony Brook University (Commack, NY)
    …for contract modeling and financial analysis. + Proven track record of successful payer relations and dispute resolution. + Demonstrated ability to develop ... changes affecting the organization. + Monitor and dispute Managed Care payer reimbursement policies or practices that breach contract terms, track resolution… more
    Stony Brook University (08/08/25)
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  • Delaware Valley ACO Fellowship

    Humana (Albany, NY)
    …data reporting, performance improvement, physician engagement, informatics, network development, and contract/ payer relations . This design gives the Fellow the ... opportunity to build fundamental communication, analytic, and problem-solving skills as well as an understanding of the ACO environment and population health strategies. To complement on-the-job training, fellows are involved in Board and other administrative… more
    Humana (07/30/25)
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  • Sr Specialist, Credentialing, Network and Payor…

    Cardinal Health (Albany, NY)
    …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
    Cardinal Health (07/24/25)
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  • Accounts Receivable Representative

    Ellis Medicine (Schenectady, NY)
    …communication (verbal, written and phone), interpersonal and positive customer relations skills required. + Certification: n/a RESPONSIBILITIES OF THE POSITION: ... meetings with all payers to continuously improve communications between provider and payer in order to resolve issues, reduce outstanding aged accounts, increase… more
    Ellis Medicine (08/13/25)
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  • Pharmacy Access Rep III - Community Pharmacy

    University of Rochester (Rochester, NY)
    …determine the reason the request was denied and prepares a response to the payer with necessary additional information. + If the denial management needs to involve ... or if physician-to-medical director conversation is needed for approval outside of the payer policy. + Documents all PAs in the appropriate location within the… more
    University of Rochester (08/13/25)
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  • Department Coordinator IV

    University of Rochester (Rochester, NY)
    …Chair of Medicine's Office for all faculty appointments, hospital privileging, and payer credentialing- - - Ensure completion of all requirements for timely ... new faculty, interviewing, contracts/recruitment, faculty appointment, hospital privileging, and payer credentialing Other Duties as assigned: - Supports seasonal… more
    University of Rochester (08/07/25)
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  • Pharmacy Access Rep III - Home Infusion

    University of Rochester (Rochester, NY)
    …not covered. + Determine if home infusion therapy being ordered meets payer requirements for coverage. Retrieve and assemble necessary information for insurance ... patient documentation. Coordinate required information for denied claims. Participate in payer audits and collect, summarize and send requested information. +… more
    University of Rochester (08/07/25)
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  • Care Management Specialist

    Charles B. Wang Community Health Center (Queens, NY)
    …and ability to utilize the care plans + Communicate and establish effective working relations with care team + Advocate and work with patient and patients' family to ... Establish linkage to external social services programs, specialist services and payer 's care management services + Participate in clinical service team… more
    Charles B. Wang Community Health Center (08/13/25)
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