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Online Resumes with "Provider dispute resolution"
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.
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.
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 ...