- CenterWell (Lansing, MI)
- …responding to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials . Works with branch staff to gather required ... to develop appropriate and timely responses. + Responsible for constructing response to denials and appeals , utilizing any federal guidelines or local coverage… more
- Molina Healthcare (Warren, MI)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing... appeals and denials . + Strong verbal and written communication skills +… more
- Molina Healthcare (Warren, MI)
- …subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises Act… more
- R1 RCM (Detroit, MI)
- …will help support clinicians who conduct a comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical ... patient care as well as conceptual knowledge of the denials landscape. Proficiency in basic computer skills is essential...**Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor the workflow of… more
- Corewell Health (Grand Rapids, MI)
- …verifies that prior authorization has been obtained; assists with retroactive insurance denials / appeals . + Responsible for complex EMR/EHR scanning and Right Fax ... faxing and uploading to EPIC. + Assists with training new team members utilizing standard work. + Ability to perform the role of Patient Services Representative, Associate when necessary. + Actively participates in safety initiatives and risk mitigating… more
- Corewell Health (St. Joseph, MI)
- …verifies that prior authorization has been obtained; assists with retroactive insurance denials / appeals . + Responsible for complex EMR/EHR scanning and Right Fax ... faxing and uploading to EPIC. + Assists with training new team members utilizing standard work. + Ability to perform the role of Patient Services Representative, Associate when necessary. + Actively participates in safety initiatives and risk mitigating… more
- Corewell Health (Watervliet, MI)
- …for communication with appropriate health insurance companies regarding authorizations and denials . Executes standard work regarding Medicaid appeals / denials ... for obtaining necessary prior authorizations, submitting documentation to appeal denials , and educating clinicians regarding proper documentation for all Inpatient… more
- Corewell Health (Grand Rapids, MI)
- …federal law, regulations, and other legal restrictions. + Assists with service line related denials and appeals . + Acts as a resource to Coders for operational ... issues. Measures coders performance to ensure that required quality / productivity levels are being met. Initiates corrective action as necessary. + Plans, organizes, and delegates work. Assists manager with performance appraisals. Recommends and initiates… more
- Trinity Health (Livonia, MI)
- …Business Services (PBS) teams, when needed, to help resolve billing, claims, denials and appeals issues affecting reimbursement. Exhibits awareness of health ... record documentation or other coding ethics concerns. Notifies appropriate leadership for assistance, resolution when appropriate. Utilizes EMR communication tools to track missing documentation or Outpatient queries that require follow-up to facilitate coding… more
- R1 RCM (Detroit, MI)
- …federal laws, writing appeals and letters to insurance companies to resolve denials , and reviewing high-balance or complex accounts. To thrive in this role, you ... a Complex Denials Consultant:** + Assist recovery staff in pursuing appeals , including the development of new and innovative legal and procedural arguments and… more