- R1 RCM (Detroit, MI)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Director of Payer Escalations ** , you will help ... new function within R1. **Here's what you will experience working as a** ** Director of Payer Escalations ** **:** + Design new provider escalations … more
- Bayer (Indianapolis, IN)
- …diverse minds to make a real difference, there's only one choice.** **Associate Director - Field Reimbursement - Oncology - Ohio Valley** **Associate Director ... (specific to Bayer Programs/Therapies); + Govt, National and local Commercial Payer experience, State Medicaid, and Managed Plans; + Experience in educating… more
- Baptist Memorial (Memphis, TN)
- …all attempts to appeal and overturn timely filing denials. + Appeal denials for payer external review and state escalations + Communicate audit results to ... departmental reporting. The position will require thorough analysis and interpretation of payer contracts as well as state and federal regulatory guidelines in order… more
- AdventHealth (Orlando, FL)
- …Responsible for reviewing Clinical Documentation and performs secondary review for escalations Evaluates and reviews charts for Quality indicators as part of ... any questions regarding level of care **_May performs peer-to-peer discussions with payer Medical Directors and/or discusses cases with payer representatives to… more
- Molina Healthcare (CA)
- …and complex Behavioral Health arrangements. Maintains network adequacy, issue escalations and JOCs. Entail heavy negotiations. Maintains critical Complex provider ... Alternative Payment Method or Value Based Payment (VBP) contracts. Issue escalations , network adequacy, Joint Operating Committees, and delegation oversight. * In… more