• Diagnosis Related Group Clinical Validation…

    Elevance Health (Dearborn, MI)
    …you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance ... of medical audit activities. + Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions. +… more
    Elevance Health (09/23/25)
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  • Specialist Charge Revenue Integrity & Optimization…

    Trinity Health (Livonia, MI)
    …**Additional Qualifications (nice to have)** + Licensure/Certification: RHIA, RHIT, CCS, CPC /COC or other coding credentials _and/or Licensed Vocational Nurse/ ... or GED + Minimum three (3) years of relevant coding and charge control work experience in a hospital...or a related field. + Strong working knowledge of medical terminology, data entry, supply chain processes, hospital and/or… more
    Trinity Health (10/01/25)
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  • Supervisor Revenue Integrity and Optimization…

    Trinity Health (Livonia, MI)
    …all Medicare and Medicaid websites, other payer websites and newsletters regarding medical policies and changes impacting charging, compliance, coding and ... practice setting. + Strong understanding of appeals, denial management, medical necessity, and coding audits with ability...1500 forms). + Licensure / Certification: RHIA, RHIT, CCS, CPC /COC, or other coding credentials strongly preferred.… more
    Trinity Health (09/09/25)
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  • HCC Risk Adjustment Coder - Full Time - Remote

    Datavant (Lansing, MI)
    …healthcare. As an HCC (Hierarchical Condition Category) coder you will review medical records to identify and code diagnoses using a standardized system, ensuring ... Review, analyze, and code diagnostic information in a patient's medical record based on client specific guidelines for the...guidelines. + Coders must meet and maintain a 95% coding accuracy rate. + Any other task requested by… more
    Datavant (08/26/25)
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  • Denials Prevention Specialist PRN

    Datavant (Lansing, MI)
    …and manage denials throughout the entire revenue cycle, including registration, eligibility, coding , billing, and medical necessity. + Analyze denial trends and ... This role requires in-depth knowledge of healthcare revenue cycle processes, HIM coding practices, and proficiency in multiple electronic systems and software tools.… more
    Datavant (09/30/25)
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  • Clinical Provider Auditor II

    Elevance Health (Dearborn, MI)
    …related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations. + ... + Requires a AA/AS and minimum of 4 years medical coding /auditing experience, including minimum of 1...experience, which would provide an equivalent background. + Requires coding certification ( CPC , CCS, CPMA). For candidates… more
    Elevance Health (09/06/25)
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  • *Revenue Integrity Specialist/Full Time/Hybrid

    Henry Ford Health System (Troy, MI)
    …with physician, nursing staff, leadership and other HFH personnel. + Knowledge of medical coding (facility and professional), related medical terminology, ... understanding of the hospital revenue cycle. CERTIFICATIONS/LICENSURES REQUIRED: + Coding Credential ( CPC , COC, CCA, CCS, RHIT)...Ford is one of the nation's most respected academic medical centers and is leading the Future of Health:… more
    Henry Ford Health System (07/24/25)
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  • Investigator

    Highmark Health (Lansing, MI)
    …to prevent further improper payments.Forwards case to the Credentialing and/or Medical Review Committee, law enforcement and regulatory agencies. + Responsible for ... to internal and external law enforcement and regulatory agencies, Credentialing or Medical Review Committee. + Engages in delivery of audit results and overpayment… more
    Highmark Health (09/10/25)
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