- Intermountain Health (Lansing, MI)
- …CDI team. + Audits and creates appeals for all payer and regulatory denials and downgrades and provides in-depth coding review, audit findings, and appeal ... strategies. + Develops and implements training plans for all internal stakeholders including coders at all levels, providers, clinical staff, compliance and the CDI team. + Audits clinical documentation and coding for complex internal and external coding… more
- Henry Ford Health System (Warren, MI)
- …tracking and resolution process. Responsible for obtaining and tracking approvals, denials , and additional information requests received from third party payers ... within the EMR. EDUCATION AND EXPERIENCE: + High School Diploma/GED + Working knowledge of computers and software systems Communication skills, verbal and written, and interpersonal skills necessary to effectively achieve department outcomes. + Minimum one (1)… more
- State of Michigan (Lansing, MI)
- …The person in this position also drafts appropriate licenses, approvals or denials for the above-referenced projects, serves as Department technical resource for ... license applicants and the public for assigned projects, and serves as the Section's expert and resource to other technical staff on hazardous waste landfill design, construction, operation and maintenance issues. All activities are to be provided in… more
- Trinity Health (Livonia, MI)
- …work assignments for colleagues. Works closely with Clinicians, Coding, Quality and Denials teams to facilitate documentation within the medical record and supports ... the patient's severity of illness, risk of mortality, clinical validity and proper DRG assignment. **ESSENTIAL FUNCTIONS** Knows, understands, incorporates, and demonstrates the mission, vision, and values of the Ministry in leadership behaviors, practices,… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …preauthorization (in some departments), resolve outstanding balances, incorrect payments, claim denials or information needed to adjudicate claims. + Work with ... clinical areas to resolve rejections and determine collectability or need for adjustment. + Process payment/claim resolution documents, making determinations on balances based on contractual arrangements and insurance coverage. + Review insurance credits and… more
- University of Michigan (Ann Arbor, MI)
- …providers + Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials ; input into appeals; share findings with providers + Review all cases with ... readmission within 30 days; report findings in Care Management software such as Allscript + Identify opportunities for cost reduction and participate in appropriate utilization management venues + Conducts referrals and consultation with Physician Advisor… more
- University of Michigan (Ann Arbor, MI)
- …Regional data and analysis requests for Charge, Payment, Avoidable Write-Offs & Denials + Works with customers to design compelling, modern visualizations via ... dashboard or reports to display actionable information for solving complex business problems. + Manage and/or administer the design and development of high-performing data models to support comprehensive data collection, loading, and extraction for complex… more
- Behavioral Center of Michigan (Detroit, MI)
- …billing information for services. Receives and processes requests for appeal of denials . Responds to complaints per UR guidelines. Maintains utilization review and ... appeal logs, as needed. Analyzes patient recrods and participates in interdisciplinary collaboration with professional staff. Facilitates education programs and advises physicians and other departments of regulations affecting utilization management. Consults… more
- Humana (Lansing, MI)
- …requests. + Process and email member letters (Letter of Agreements, Approvals, Denials etc.) + Assist the team with various clerical/administrative tasks as ... necessary. + Participate in special projects as assigned by your Supervisor or Manager **Use your skills to make an impact** **Required Qualifications** + Bilingual English/Spanish able to speak, read and write in both languages without limitations or… more
- Trinity Health (Livonia, MI)
- …support diagnosis code and MS-DRG, APR DRG assignments to potentially decrease denials . 5. Works Inpatient claim edits and may code consecutive/combined accounts to ... comply with the 72-hour rule and other account combine scenarios. 6. Adheres to Inpatient coding quality and productivity standards established by Revenue Excellence/HM. 7. Demonstrates knowledge of current, compliant coder query practices when consulting with… more