- Datavant (Lansing, MI)
- …realize our bold vision for healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of ... Nurse or Registered Nurse well versed in DRG downgrade denials and appeal writing for inpatient admission. Experience with...Nurse or Registered Nurse well versed in DRG downgrade denials and appeal writing for inpatient admission. Experience with… 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 care management outcomes and fulfills the… more
- Henry Ford Health System (Detroit, MI)
- …Campus, Centralized Pharmacy Services Center - Detroit Schedule: Full Time The Pharmacy Specialist is a pharmacist who, by virtue of knowledge gained through special ... expert in a major area of pharmacy practice. The Pharmacy Specialist assumes overall leadership responsibility in directing the pharmacy-related activities in… 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 (Troy, MI)
- …SUMMARY: Reporting to the Manager, Revenue Integrity, the Revenue Integrity Specialist identifies revenue opportunities and works collaboratively with Revenue Cycle ... workflows. Primary areas of focus include revenue capture accuracy, decreased denials utilizing standard optimized workflow, and reducing organization risk by… more
- Henry Ford Health System (Troy, MI)
- …and assisting the supervisor with escalated issues. The CBO Coding Senior Specialist confirms the accuracy and completeness of coding to ensure compliant claims ... are sent to payers. The CBO Coding Senior Specialist works independently to resolve complex diagnostic accounts. The...sending out clean quality claims and working and preventing denials . EDUCATION/EXPERIENCE REQUIRED: + High school diploma or GED… more
- Molina Healthcare (Grand Rapids, 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
- 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
- Guidehouse (Detroit, MI)
- …to pre-bill claim edits, hospital billing scrubber bill hold edits, and claim denials . **This position is 100% remote** .Daily duties for this position include: + ... Responsible for daily resolution of assigned claims with Revenue Integrity specific denials in the Guidehouse METRIX℠ system. + Ensures coding and billing practices… more
- Henry Ford Health System (Detroit, MI)
- …ensure compliant claims to Third party payers. Resolves problem accounts from payer denials and follows up on any claims that require a payer response. Responsible ... receivables. + Expert knowledge in all claims processing, including claims submissions , denials , and follow up procedures used to train other team members +… more