- Datavant (Lansing, MI)
- …Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal writing for inpatient admission. Experience with clinical criteria ... Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal writing for inpatient admission. Experience with clinical criteria… more
- Oracle (Lansing, MI)
- …for appeals packets, identify trends/improvement opportunities to prevent future denials , and ensure maximum appropriate reimbursement. This role is critical ... for financial recovery and ultimate prevention of complex, high-dollar claim denials . **Qualifications** + 3+ years hands on experience preparing appeals for claim … more
- Henry Ford Health System (Detroit, MI)
- …of the infusion patient access hub providing seamless patient access, minimize claim denials , and resolve payer issues for infusion and injection therapies. + Data ... cycle principles, charge capture processes, and compliance best practices. + Denials Management & Process Optimization: Oversee pharmaceutical claim denials … more
- McLaren Health Care (Mount Pleasant, MI)
- …resolution, process improvement initiatives, and response to inquiries to payer denials . **Essential Functions and Responsibilities as Assigned:** 1. Supports ... activities consistent with Integrated Care Management Denials across all MHC subsidiaries. 2. Accountable for achieving...to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are… more
- Trinity Health (Livonia, MI)
- …knowledge to ensure continuous quality improvement. Conducts facility analysis of denials . Prepares and submits review findings, makes recommendations, and works ... understanding of regulatory and payer changes. Special note for Physician Billing Denials Prevention - Additional nice to have qualification: 3 years revenue cycle,… more
- Henry Ford Health System (Detroit, MI)
- …for pre- and post-payment audit processes. This is more than managing denials -it's about driving payer behavior change, leveraging data to influence outcomes, and ... is responsible for overseeing pre- and post-payment audit processes, managing denials and appeals, and driving payer behavior change through data-driven insights… more
- Cardinal Health (Lansing, MI)
- …client satisfaction. + Resolves complex insurance claims, including appeals and denials , to ensure timely and accurate reimbursement. + Verifies patient eligibility ... states on paper and online. + Oversees appeals and denials management to maximize revenue recovery and minimize financial...changes that may need to be made. + Processes denials & rejections for re-submission (billing) in accordance with… more
- University of Michigan (Ann Arbor, MI)
- …Query Policy. + Skilled in writing appeal letters to third-party payers to support DRG denials . + Attention to detail to perform tasks with accuracy. + Able to work ... procedures. + Review and provide documentation to support appeals for DRG denials from third-party payers to prevent financial loss. + Implement corrective action… more
- Molina Healthcare (MI)
- …and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals ... and denials . * Customer service experience. * Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal… more
- University of Michigan (Ann Arbor, MI)
- …appeal based on medical necessity, level of care, administrative and outpatient denials . They manage and respond to Medicare, Medicare Advantage, Varis, Medicaid and ... regulatory knowledge as well as knowledge of payer requirements to determine reasons for denials and what type of appeal is required. + Make appeal referrals to both… more