- Covenant Health Inc. (Knoxville, TN)
- …medicine and urology. Position Summary: Demonstrates knowledge of Medicare and payer billing guidelines and policies. Demonstrates ability to promptly review, ... interpret and communicate current and changes to published Medicare and other payer billing guidelines/policies. The Billing Liaison must be able to answer policy… 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 ... hospital resource utilization, reduce readmissions, and maintain compliance with payer requirements. **Essential Functions** + Performs admission and continued stay… more
- HCA Healthcare (Hendersonville, TN)
- …member of hospital's peer review committees as requested. Business Development and Payer Relations : + Evaluates clinical appropriateness of new medical ... program development, and overall hospital strategy. + Provides medical director services to facility-level physician credentialing, business development, and… more
- Covenant Health Inc. (Knoxville, TN)
- …continuance of productivity and positive morale. This position assists the department Director and the Vice President in establishing and meeting strategic goals and ... which requires a working knowledge of several service lines and payer requirements. ###@covhlth.com Responsibilities Integrity + Maintains accountability for the… more
- 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 ... letter of medical necessity is needed or if physician-to-medical director conversation is needed for approval outside of the... conversation is needed for approval outside of the payer policy. + Documents all PAs in the appropriate… more
- Covenant Health Inc. (Knoxville, TN)
- …course of action for proper resolution. + Responsible for learning & understanding payer rules, as well as state/federal guidelines. + Responsible for prioritizing & ... guidelines, HCFA guidelines, TennCare guidelines and other Third Party Payer requirements assuring departmental compliance. + Recognizes situations, which… more
- University of Rochester (Rochester, NY)
- …a department, in addition to serving as the principal assistant to Senior Director (s), Director (s), Associate Director (s), or other leadership roles. ... Chair of Medicine's Office for all faculty appointments, hospital privileging, and payer credentialing- - - Ensure completion of all requirements for timely… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …requirements unique to the industry. **SUPERVISORY RESPONSIBILITIES:** Direct Reports ▪ Sr Director Payer Contracting and Performance ▪ Sr Director ... Affairs, including local, state and national regulatory, legislative and government relations . Oversees a patient-centric legislative agenda and advocacy in support… more
- Covenant Health Inc. (Knoxville, TN)
- …guidelines, HCFA guidelines, TennCare guidelines and other Third Party Payer requirements assuring departmental compliance. + Recognizes situations, which ... program and safety standards. + Demonstrates an ability to understand the payer requirements of insurance carriers. + Demonstrates an understanding of all patient… more
- East Boston Neighborhood Health Center (Revere, MA)
- …to enroll a provider with the payers and the requirements of each payer . + Gathers and disseminates information to appropriate administrative stakeholders to ensure ... to date every 90 days to avoid delays with payer credentialing and recredentialing. + Answers phone calls and...Staff Office information, referring to the Credentialing Manager and/or Director any issues beyond the scope of this position.… more