- Molina Healthcare (Detroit, MI)
- …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... **Job Qualifications** **REQUIRED QUALIFICATIONS:** + Experience demonstrating knowledge of CMS Guidelines, MCG, InterQual or other medically appropriate clinical… more
- Molina Healthcare (Sterling Heights, MI)
- …with Medicare Advantage or Medicaid programs + Awareness of CMS audit processes or healthcare compliance requirements **Ideal Candidate Attributes** + **Curious ... Adjustment Data Validation) team, assisting in the execution of CMS and internal audit activities. This position contributes to...the generation of chart retrieval chase lists based on CMS audit samples and internal data logic. + Use… more
- University of Michigan (Ann Arbor, MI)
- …Appeals Specialist will collaborate with multiple departments to maintain compliance with CMS regulations and third party payer requirements. They appeal based on ... of care, administrative and outpatient denials. They manage and respond to Medicare , Medicare Advantage, Varis, Medicaid and other various commercial audits.… more
- Molina Healthcare (MI)
- …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... including assisting and executing projects and tasks to ensure CMS and State regulatory requirements are met for pre-pay...At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept… more
- Trinity Health (Livonia, MI)
- …of Health & Human Services (DHHS) - Office of Inspector General (OIG), Centers for Medicare & Medicaid Services ( CMS ), Department of Justice (DOJ) as well as ... Must understand and have in depth knowledge of Hospital Outpatient Prospective Payment System , Inpatient Prospective Payment System , Medicare Physician Fee… more
- Humana (Lansing, MI)
- … management . + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Nurse Team Lead plays a key role in supporting the day-to-day operations of the UM team and serves as a liaison between frontline ... but are not limited to: + Support the day-to-day operations of the Utilization Management team + Provide leadership, guidance, and training support to the team of… more
- Molina Healthcare (Sterling Heights, MI)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare , or equivalent combination of relevant education and experience + Proven… more
- CVS Health (Lansing, MI)
- …records coded by internal teams prior to the submission to the Centers of Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes ... record documentation review, diagnosis coding, and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical… more
- Intermountain Health (Lansing, MI)
- …alignment with ICD-10-CM and Official Coding Guidelines as determined by Centers for Medicare and Medicaid Services ( CMS ), National Center for Health Statistics ... Services (DHHS), American Hospital Association (AHA) and American Health Information Management Association (AHIMA). This position provides advanced training to CDI… more