- Lincoln Financial (Lansing, MI)
- …for this opportunity. **Requisition #:** 74565 **The Role at a Glance** As an Appeals Specialist you will be responsible for being a product subject matter ... for multiple product lines. You will perform and deliver on appeals claims assignments/projects while simultaneously leveraging and applying knowledge. You will… more
- Molina Healthcare (Warren, MI)
- …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving member ... appeals and communicating resolution to members and provider (or...Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers… more
- Molina Healthcare (Warren, MI)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises Act ... + Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including coordination… more
- Molina Healthcare (Sterling Heights, MI)
- …request authorization. Strongly prefer candidates with a background in appeals and grievances. Excellent computer multi-tasking skills and good productivity ... office with internet connectivity of high speed required **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for … more
- State of Michigan (Lansing, MI)
- Departmental Specialist 13 - Specialized Nursing Home OBRA Program Print (https://www.governmentjobs.com/careers/michigan/jobs/newprint/4996564) Apply Departmental ... Specialist 13 - Specialized Nursing Home OBRA Program Salary.... Reviews, coordinates and represents the Department on statewide appeals of preadmission screenings/annual resident reviews Medicaid recoveries before… more
- CenterWell (Lansing, MI)
- …caring community and help us put health first** The **Denials Management Specialist ** is responsible to respond to, monitor and analyze all governmental requests, ... to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials. Works with branch staff to gather required information and… more
- R1 RCM (Southfield, MI)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **PAS Support Specialist ** , you will help our Physician Advisory Services team by ... submitting the required documents for prepared appeals . Every day you will review and gather medical...what you will experience working as a PAS Support Specialist :** + Collate appeal packages to be submitted to… more
- Molina Healthcare (Warren, MI)
- …Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the ... analyses of advocacy issues; and assists with documentation preparation for appeals , fair hearings or other formal/informal dispute resolution process. * Provides… more
- CVS Health (Lansing, MI)
- …**Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Ensures all compliance requirements are satisfied and all… more
- Corewell Health (Southfield, MI)
- …HIM and Revenue Cycle professionals in third party payer DRG audits and appeals . + Educates members of the healthcare team about clinical documentation guidelines, ... Doctor Degree, MD with CCDS or CDIP + Certified Clinical Documentation Specialist , CCDS or Documentation Improvement Practitioner About Corewell Health As a team… more