... CDRU, Payor Audit, hospital UM teams, system IPAS, managed care contracting, and legal. 3. ... R
... CDRU, Payor Audit, hospital UM teams, system IPAS, managed care contracting, and legal. 3. ... R
... CDRU, Payor Audit, hospital UM teams, system IPAS, managed care contracting, and legal. 3. ... Previous performance-based leadership experience preferred. #PR Additional Information
... CDRU, Payor Audit, hospital UM teams, system IPAS, managed care contracting, and legal. 3. ... Previous performance-based leadership experience preferred. #PR Additional Information
Stresses Payor/Referral satisfaction. Effectively interacts with patients, families, and visitors to enhance guest relations. Represents the facility in all contacts with other health professionals ...
Stresses Payor/Referral satisfaction. Effectively interacts with patients, families, and visitors to enhance guest relations. Represents the facility in all contacts with other health professionals ...
Coordinate timely completion of required activities and reports to maintain compliance with payor ... Manage communications through media relations including leading development of the network's Annual ...
Coordinate timely completion of required activities and reports to maintain compliance with payor ... Manage communications through media relations including leading development of the network's Annual ...
Coordinate timely completion of required activities and reports to maintain compliance with payor ... Manage communications through media relations including leading development of the network's Annual ...
Coordinate timely completion of required activities and reports to maintain compliance with payor ... Manage communications through media relations including leading development of the network's Annual ...
... all payor sources, updating the accounting systems at the nursing facility and those which ... Relations Act.
Quick apply
... all payor sources, updating the accounting systems at the nursing facility and those which ... Relations Act.
Medical Science Liaison, Cardiovascular - Central North
Detroit, MI · On-site
$185 - $215/hr
... and payor community. The MSL is responsible for establishing, developing and maintaining the ... information in relation to our portfolio. * Develop scientific expertise in the area of ...
Medical Science Liaison, Cardiovascular - Central North
Detroit, MI · On-site
$185 - $215/hr
... and payor community. The MSL is responsible for establishing, developing and maintaining the ... information in relation to our portfolio. * Develop scientific expertise in the area of ...
Medical Science Liaison, Cardiovascular - Central North
Detroit, MI · On-site
$185 - $215/hr
... and payor community. The MSL is responsible for establishing, developing and maintaining the ... information in relation to our portfolio. * Develop scientific expertise in the area of ...
Medical Science Liaison, Cardiovascular - Central North
Detroit, MI · On-site
$185 - $215/hr
... and payor community. The MSL is responsible for establishing, developing and maintaining the ... information in relation to our portfolio. * Develop scientific expertise in the area of ...
Medical Science Liaison, Cardiovascular - Central North
Dearborn Heights, MI · On-site
$185K - $215K/yr
... and payor community. The MSL is responsible for establishing, developing and maintaining the ... information in relation to our portfolio. * Develop scientific expertise in the area of ...
Medical Science Liaison, Cardiovascular - Central North
Dearborn Heights, MI · On-site
$185K - $215K/yr
... and payor community. The MSL is responsible for establishing, developing and maintaining the ... information in relation to our portfolio. * Develop scientific expertise in the area of ...
Medical Science Liaison, Cardiovascular - Central North
Dearborn Heights, MI · On-site
$185K - $215K/yr
... and payor community. The MSL is responsible for establishing, developing and maintaining the ... information in relation to our portfolio. * Develop scientific expertise in the area of ...
Medical Science Liaison, Cardiovascular - Central North
Dearborn Heights, MI · On-site
$185K - $215K/yr
... and payor community. The MSL is responsible for establishing, developing and maintaining the ... information in relation to our portfolio. * Develop scientific expertise in the area of ...
... reporting, payor contract management, and control/monitoring of financial functions. Utilizing ... Prepares general journal entries in relation to monthly closing of financial records * Maintains ...
... reporting, payor contract management, and control/monitoring of financial functions. Utilizing ... Prepares general journal entries in relation to monthly closing of financial records * Maintains ...
Referral Coordinator
Battle Creek, MI · On-site
$17 - $22.25/hr
... relations with office staff and employees in a team environment. • Must maintain the highest ... payor issues. • Manages electronic health record referral/order work queues according to office ...
Referral Coordinator
Battle Creek, MI · On-site
$17 - $22.25/hr
... relations with office staff and employees in a team environment. • Must maintain the highest ... payor issues. • Manages electronic health record referral/order work queues according to office ...
Referral Coordinator
Kalamazoo, MI · On-site
$17 - $22.25/hr
... relations with office staff and employees in a team environment. • Must maintain the highest ... payor issues. • Manages electronic health record referral/order work queues according to office ...
Referral Coordinator
Kalamazoo, MI · On-site
$17 - $22.25/hr
... relations with office staff and employees in a team environment. • Must maintain the highest ... payor issues. • Manages electronic health record referral/order work queues according to office ...
Referral Coordinator - Neuroscience Center
$17 - $22.25/hr
Ability to establish effective working relations with office staff and employees in a team ... Maintain excellent customer service, including problem-solving payor issues. Manages electronic ...
Referral Coordinator - Neuroscience Center
$17 - $22.25/hr
Ability to establish effective working relations with office staff and employees in a team ... Maintain excellent customer service, including problem-solving payor issues. Manages electronic ...
... relation to Amgen Cardiovascular products and plan/execute actions for success in these accounts ... Experience in public payor / agency activities, including understanding of the Local Coverage ...
... relation to Amgen Cardiovascular products and plan/execute actions for success in these accounts ... Experience in public payor / agency activities, including understanding of the Local Coverage ...
... payor-mix and census objectives. * Collects records and analyzes admitting statistics and reports these to required offices. * Facilitates increased community relations with referral sources ...
... payor-mix and census objectives. * Collects records and analyzes admitting statistics and reports these to required offices. * Facilitates increased community relations with referral sources ...
... member relations over the phone and during day-to-day center operations. Duties and ... Appropriately report all critical incidents and safety concerns in accordance with payor ...
... member relations over the phone and during day-to-day center operations. Duties and ... Appropriately report all critical incidents and safety concerns in accordance with payor ...
... relation to Amgen Cardiovascular products and plan/execute actions for success in these accounts ... Experience in public payor / agency activities, including understanding of the Local Coverage ...
... relation to Amgen Cardiovascular products and plan/execute actions for success in these accounts ... Experience in public payor / agency activities, including understanding of the Local Coverage ...
... payor-mix and census objectives. * Collects records and analyzes admitting statistics and reports these to required offices. * Facilitates increased community relations with referral sources ...
... payor-mix and census objectives. * Collects records and analyzes admitting statistics and reports these to required offices. * Facilitates increased community relations with referral sources ...
... payor-mix and census objectives. * Collects records and analyzes admitting statistics and reports these to required offices. * Facilitates increased community relations with referral sources ...
... payor-mix and census objectives. * Collects records and analyzes admitting statistics and reports these to required offices. * Facilitates increased community relations with referral sources ...
Payor Relations information
What is a payor relations?
A Payor Relations job involves managing relationships between healthcare providers and insurance companies (payors) to ensure smooth contract negotiations, reimbursement processes, and compliance with regulations. Professionals in this role work to secure favorable payment terms, resolve disputes, and stay updated on policy changes. They collaborate with internal teams like finance and billing to optimize revenue cycle management and improve patient access to care.
What are the key skills and qualifications needed to thrive in the payor relations position, and why are they important?
To thrive in Payor Relations, you need a strong background in healthcare administration, contract negotiation, and knowledge of reimbursement methodologies, often supported by a bachelor’s degree in business, healthcare, or a related field. Proficiency with claims management systems, contract management software, and familiarity with regulatory compliance tools like HIPAA is typically required. Excellent communication, relationship-building, and problem-solving abilities help foster productive partnerships with insurance payors and internal stakeholders. These skills are vital for ensuring favorable contract terms, resolving disputes efficiently, and supporting the financial goals of healthcare organizations.
What are some common challenges faced in a payor relations role, and how are they typically managed?
Professionals in Payor Relations often encounter challenges such as navigating complex contract negotiations, resolving claim denials, and staying updated with constantly evolving insurance regulations. Managing these challenges typically involves collaborating closely with internal teams like billing, compliance, and finance, as well as maintaining open communication with representatives from insurance payors. Successful payor relations specialists leverage negotiation skills, industry knowledge, and data analysis to address issues efficiently and advocate for their organization’s interests. Staying proactive and adaptable is key to ensuring smooth operations and maintaining strong partnerships between healthcare providers and payors.
What are the most commonly searched types of Payor Relations jobs in Michigan? The most popular types of Payor Relations jobs in Michigan are:
What are popular job titles related to Payor Relations jobs in Michigan? For Payor Relations jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Payor Relations jobs in Michigan look for? The top searched job categories for Payor Relations jobs in Michigan are:
- Foundation Relations Director
- Director Of Corporate And Foundation Relations
- Government Relations Coordinator
- Director Payor Relations
- Director Customer Relations
- Assistant Nba Community Relations
- Director Government Relations
- Fulltime Government Relations Lobbyist
- Director Medicare Advantage
- Investor Relations Japanese
Medical Director - Clinical Denial Recovery Unit (CDRU)/Payor Audit
Detroit, MI • On-site
Full-time
Re-posted 14 days ago
Henry Ford Health rating
7.0
Based on 564 frontline employees who took The Breakroom Quiz
416th of 887 rated healthcare providers
Job description
GENERAL SUMMARY:
Reports to the Chief Utilization Officer (CUO) of Henry Ford Health, responsible for Clinical Denial Recovery Unit (CDRU) operations. Responsible for strategic and operational leadership and oversight of programs and initiatives including denials management, performance improvement, regulatory, compliance, and risk with an expectation of national top decile performance. This system role includes physician oversight and clinical input for post-discharge medical necessity denials at all HFHS acute care facilities.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
1. Oversee a comprehensive value-driven centralized denial management process.
2. In collaboration with executive and administrative partners, provide clinical expertise to CDRU, Payor Audit, hospital UM teams, system IPAS, managed care contracting, and legal.
3. Participate as a clinical expert in payer negotiations and escalations, Accounts Receivable Reconciliation Group (AARGs) and Medical Director Meetings (MDMs), and during Administrative Law Judge (ALJ) hearings for denied cases.
4. Standardize and oversee a comprehensive reliability-driven process for status determination in concert with site level physician advisors.
5. Prepare and analyze denial metrics and make recommendations for process improvements.
6. Provide feedback to system IPAS regarding denial trends, opportunities for improvement, and payor practices.
7. Report out metrics and initiatives at Medical Executive and Executive Leadership meetings as requested.
8. Assist the manager of CDRU, UM Director, and Director of Payor Audit with preparation of case escalations for payer negotiations.
9. Assist the CDRU RN staff with medical necessity appeals for complex medical cases.
10. Maintain a working knowledge of applicable Federal, State and local laws and regulations, initiatives, and expectations as set by payers and CMS.
11. Collaborate with accountable leaders to develop processes that ensure consistent feedback for all involved care providers regarding specific denial mitigation strategies and performance results.
#PR
EDUCATION/EXPERIENCE REQUIRED:
• Graduate of an accredited medical school, completion of a three (3) year U.S. residency program, and board certified in their specialty.
• Minimum seven (7) years of clinical practice as a physician.
• Previous performance-based leadership experience preferred.
#PR
Reports to the Chief Utilization Officer (CUO) of Henry Ford Health, responsible for Clinical Denial Recovery Unit (CDRU) operations. Responsible for strategic and operational leadership and oversight of programs and initiatives including denials management, performance improvement, regulatory, compliance, and risk with an expectation of national top decile performance. This system role includes physician oversight and clinical input for post-discharge medical necessity denials at all HFHS acute care facilities.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
1. Oversee a comprehensive value-driven centralized denial management process.
2. In collaboration with executive and administrative partners, provide clinical expertise to CDRU, Payor Audit, hospital UM teams, system IPAS, managed care contracting, and legal.
3. Participate as a clinical expert in payer negotiations and escalations, Accounts Receivable Reconciliation Group (AARGs) and Medical Director Meetings (MDMs), and during Administrative Law Judge (ALJ) hearings for denied cases.
4. Standardize and oversee a comprehensive reliability-driven process for status determination in concert with site level physician advisors.
5. Prepare and analyze denial metrics and make recommendations for process improvements.
6. Provide feedback to system IPAS regarding denial trends, opportunities for improvement, and payor practices.
7. Report out metrics and initiatives at Medical Executive and Executive Leadership meetings as requested.
8. Assist the manager of CDRU, UM Director, and Director of Payor Audit with preparation of case escalations for payer negotiations.
9. Assist the CDRU RN staff with medical necessity appeals for complex medical cases.
10. Maintain a working knowledge of applicable Federal, State and local laws and regulations, initiatives, and expectations as set by payers and CMS.
11. Collaborate with accountable leaders to develop processes that ensure consistent feedback for all involved care providers regarding specific denial mitigation strategies and performance results.
#PR
EDUCATION/EXPERIENCE REQUIRED:
• Graduate of an accredited medical school, completion of a three (3) year U.S. residency program, and board certified in their specialty.
• Minimum seven (7) years of clinical practice as a physician.
• Previous performance-based leadership experience preferred.
#PR
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About Henry Ford Health
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Henry Ford Health provides a full continuum of services from Primary and Preventative care, to Complex and Cpecialty care, Health Insurance, a full suite of home health offerings, Virtual care, Pharmacy, Eye care and other Healthcare retail. It is one of the Nation’s leading Academic Medical Centers, recognized for Clinical excellence in Cancer care, Cardiology and Cardiovascular Surgery, Neurology and Neurosurgery, Orthopedics and Sports medicine, and Multi organ transplants. Consistently ranked among the top five NIH funded institutions in Michigan, Henry Ford Health engages in more than 2,000 research projects annually. Equally committed to educating the next generation of Health Professionals, Henry Ford Health trains more than 4,000 Medical students, Residents and fellows every year across 50+ accredited programs. With more than 33,000 valued team members, Henry Ford Health is also among Michigan’s largest and most Diverse employers, including nearly 6,000 physicians and researchers from the Henry Ford Medical Group, Henry Ford Physician Network and Jackson Health Network.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Detroit, MI, US
Year founded
1915