- Molina Healthcare (Grand Rapids, MI)
- …utilized in medical coding/billing (UB04/1500 form). * Demonstrated understanding of key managed care concepts and provider reimbursement principles such ... health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) * Proficiency with retrieving specified… more
- Highmark Health (Lansing, MI)
- …various complex potential claims with emphasis on controlling losses through effective managed care . This includes following a departmental claim checklist to ... ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for...3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate… more
- AmeriHealth Caritas (Detroit, MI)
- …working with healthcare providers and provider relations + 3 years of experience in managed care or health insurance preferred. + Proficiency in Microsoft Excel ... **Role Overview:** The Provider Network Operations Data Analyst plays a key role in maintaining accurate...and accurate management of provider contracts, including terms and reimbursement details. + Investigate and respond to member complaints… more
- Molina Healthcare (MI)
- …+ Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical and ... Qualifications** + At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent… more
- Molina Healthcare (MI)
- …Qualifications** + At least 2 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent ... and/or functional requirements related to but not limited to coverage, reimbursement , and processing functions to support systems solutions development and… more
- Molina Healthcare (Detroit, MI)
- …gaps. * Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment integrity ... **Required Qualifications** * At least 5 years of business analyst experience in a managed care...concept to execution, especially in the areas of provider reimbursement and claims payment integrity. * Strong working knowledge… more