- Molina Healthcare (Ann Arbor, MI)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within ... compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews of previously denied cases in which… more
- Intermountain Health (Lansing, MI)
- …provides advanced training to hospital coding staff, compliance, CDI, physicians, and clinical staff. This Coordinator serves as a subject matter expert for all ... of hospital coding. The coordinator works with providers and clinical staff to make critical coding decisions based on...compliance and the CDI team. + Audits and creates appeals for all payer and regulatory denials and downgrades… more
- Corewell Health (Watervliet, MI)
- …and educate clinicians on documentation quality and compliance to improve clinical outcomes, and maximize reimbursement. Collaborate with coding, billing, denials ... regarding authorizations and denials. Executes standard work regarding Medicaid appeals /denials, change requests, and all insurance authorizations. + Educates… more
- Evolent (Lansing, MI)
- …guidance and expertise to ensure the application of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations ... Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular… more
- Henry Ford Health System (Detroit, MI)
- …and compliance risks. + Provides instruction to department staff and clinical employees in correct documentation processes and coding guidelines. + Provides ... instruction based on clinical documentation requirements related to regulatory and reimbursement rules and regulations, reimbursement systems (federal, state, and… more
- Trinity Health (Livonia, MI)
- …and references, in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes and Current Procedural ... Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification + The American Medical Association _(AMA_ ) for CPT… more
- Trinity Health (Livonia, MI)
- …and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes, MS-DRG, APR DRG, POA, ... documentation, as part of the coding process, to assess the presence of clinical evidence/indicators to support diagnosis code and MS-DRG, APR DRG assignments to… more
- Trinity Health (Livonia, MI)
- …and references in the assignment of Internal Classification of Diseases, Clinical Modification diagnosis and procedure codes, and Current Procedural Terminology / ... of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional… more
- Trinity Health (Livonia, MI)
- …and references in the assignment of Internal Classification of Diseases, Clinical Modification diagnosis and procedure codes, and Current Procedural Terminology / ... National Coverage Determination and CCI Edits. Communicates effectively with clinical staff, physicians and office staff regarding documentation issues or… more