- Sedgwick (Lansing, MI)
- …Fortune Best Workplaces in Financial Services & Insurance Provider Network Specialist **PRIMARY PURPOSE** **:** To ensure clients and Managed Care Organization's ... MCO provider additions and removals, MCO network issues; makes recommendations for resolution . + Contacts providers to verify new workers' compensation patients are… more
- McLaren Health Care (Flint, MI)
- …of the laboratory department and revenue cycle department leadership, the Lab Billing Specialist works on resolution efforts for coding and billing problems that ... prevent submission of insurance claims as well as technical denials for claims not paid. Works closely with Coding and Billing departments in this effort.… more
- Molina Healthcare (Sterling Heights, MI)
- …and timely validation and maintenance of critical provider information on all claims and provider databases (using SQL, Excel, and QNXT). Staff ensure adherence ... areas of responsibility (eg, Provider Services/Provider Inquiry Research & Resolution , Provider Contracting/Provider Relationship Management). + Provides timely, accurate… more
- Ford Motor Company (Allen Park, MI)
- …maneuvers or during a failed battery state. **3. Quality, Reliability & Problem Resolution :** + Lead the investigation, root cause analysis, and resolution of ... testing), and formal sign-off processes. + **Quality, Reliability & Problem Resolution :** Extensive experience in leading root cause analysis, problem-solving, and … more
- Molina Healthcare (Ann Arbor, MI)
- …for reviewing and resolving member & provider complaints and communicating resolution to members (or authorized) representatives in accordance with the standards ... and grievances. + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial letters. + Assists...**C** **E:** + 1 year of Molina experience, health claims experience, OR one year of customer service/provider service… more
- Cognizant (Lansing, MI)
- …comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution . You will be a valued member of the Cognizant team and ... accounts. . Maintain working knowledge of applicable health insurers' internal claims , appeals, and retro-authorization as well as timely filing deadlines and… more
- Corewell Health (Grand Rapids, MI)
- …is responsible for the oversight of the provider enrollment data and issue resolution arising throughout the entire Priory Health eco system. Operation Analyst must ... systems accurately and timely to ensure the annual multi-million-dollar claims payout and the annual multi-million-dollar Physician Incentive Program settlement… more
- Molina Healthcare (Sterling Heights, MI)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... and finance partners to proactively identify issues and implement resolution strategies. + Serves as a thought partner to...a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +… more
- McLaren Health Care (Shelby Township, MI)
- …and human resources. **BILLING:** Responsible for billing hospital and physician claims , for inpatients and outpatients treated in the hospital and clinic, ... requirements. + Performsnecessary maintenance to patient accounts in the billing and claims editing systems. + Responds timely to all patient and commercial… more
- University of Michigan (Ann Arbor, MI)
- …plays a vital role in ensuring transparent, effective communications, problem resolution , and relationship oversight exists between the MCCO Department and Payers. ... and interpret data related to managed care programs, including reimbursement rates, claims data, and provider performance metrics. + Collect and maintain information… more
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