- Corewell Health (Grand Rapids, MI)
- Job Summary As a Patient Services Representative with Corewell Health, you'll play a vital role in delivering top-notch healthcare service to our patients. You'll ... that prior authorization has been obtained; assists with retroactive insurance denials/ appeals . + Responsible for complex EMR/EHR scanning and Right Fax faxing… more
- Molina Healthcare (Ann Arbor, MI)
- …+ Provides coordination and processing of pharmacy prior authorization requests and/or appeals . + Explains Point of Sale claims adjudication, state, NCQA, and CMS ... member and providers with initiating oral and written coverage determinations and appeals . + Records calls accurately in call tracking system. + Maintains specific… more
- Intermountain Health (Lansing, MI)
- …such as debits/credits, required + Experience with insurance claim appeals , required + Excellent computer skills (including Microsoft Office applications), ... required- Familiarity with electronic remittances, required **Physical Requirements** + Interact with others by effectively communicating, both orally and in writing + Operate computers and other office equipment requiring the ability to move fingers and hands… more
- Cardinal Health (Lansing, MI)
- …the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes ... denials & rejections for re-submission (billing) in accordance with company policy, regulations, or third-party policy. + More challenging claim cases + Investigates and updates the system with all information received from secondary insurance companies. +… more
- CVS Health (Lansing, MI)
- …new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system. + Assists providers with credentialing/re-credentialing and ... contracting questions and issues. + Assist in compiling claim data for audits. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals. + Work hours will be… more
- Highmark Health (Lansing, MI)
- …correspondence inquiries (routine, priority Congressional / Department of Defense), and appeals . Ensures that all processes are compliant with requirements and ... Provides direction for priority Congressional and Department of Defense inquiries and appeals . + Performs administration tasks such as leave approvals and functions… more
- Cardinal Health (Lansing, MI)
- …appropriate team member (when applicable) + Resolve patient's questions and any representative for the patient's concerns regarding status of their request for ... + Must follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be… more
- Justice, Bureau of Prisons/Federal Prison System (Milan, MI)
- …in security designations and custody classification. Experience entering and tracking appeals filed by inmates and assisting with researching and preparing responses ... to inmate appeals . Experience in providing assistance to contractors in the...This position IS included in the bargaining unit. The representative rate for this position is $89,710 per annum… more
- Banner Health (MI)
- …the best place to work and receive care. The **PFS Insurance Follow-Up Representative (Ambulatory Denials)** is responsible for following up with assigned payer for ... payments, contract discrepancies, incorrect financial classes, internal/external errors. Makes appeals and corrections as necessary. 4. Builds strong working… more
- Cardinal Health (Lansing, MI)
- …insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed + Resolve patient's questions and any representative ... for the patient's concerns regarding status of their request for assistance + Demonstrate expertise in payer landscapes and insurance processes. Remain knowledgeable about long and short-range changes in the reimbursement environment including Medicare,… more