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Online Resumes with "Provider dispute resolution"

Sr. Director of Contracts

Lead a team of Contract or Procurement professionals, negotiate contract terms, provide dispute resolution, manage out sourced services and create and draft agreements, provide contract administration and compliance activities.

Tags for this Online Resume: Contract Director, Sales Operations, Senior Negotiator, Licensing, Procurement, FAR

Admissions Director - 9 Years of Experience - Near 91387

Summary of Qualifications: Over 10 years of Director experience in claims, regulatory and compliance, appeals and provider dispute resolution, recoveries and cost containment. Employee with excellent customer service, interpersonal, organizations and analytical faculties, a highly dedicated and capable employee, who works well both independently and as a component of a team.

Tags for this Online Resume: Audit, Policies and Procedures, FACETS, Outsourcing, Cms, Coding, Management, Medicare, Quality, Quality Assurance

Registered Nurse - 20 Years of Experience - Near 95670

Career Summary: Over 20 years of experience in Acute Care and Health Service programs including Utilization Review, Provider Dispute Resolution, Quality Management, Inpatient and Ambulatory Case Management, and Grievance and Appeals in a managed care environment for both Health Plan and IPA/MSO settings using evidence based nationally recognized criteria such as ACOG, NCCN, MCG, InterQual and Health Plan Medical guidelines ...

Tags for this Online Resume: Compliance, Management, Quality Management, Assessments, Medical, Medicare, registered nurse, healthcare, Managed Care, Utilization Management

Claims Adjuster

Tags for this Online Resume: Policies and Procedures, Audit, Complaints, Crystal Reports, Services, Code Review, Coding, CSC, Deductions, Quality