- Henry Ford Health System (Troy, MI)
- …This includes but is not limited to: Coordinating timely and accurate claims submission for adjudication Coordinating and developing timely denial follow ... the designated area of responsibility to provide timely billing processing and ensure accurate response to customers. Builds and...to prevent denials. Oversee follow up to ensure all claims are resolved or responded to by the payers.… more
- Corewell Health (Grand Rapids, MI)
- …Specialty Pharmacy Scope of Work Coordinates prior authorization and prescription processing in collaboration with the Corewell Health Specialty Pharmacy ... offices and specialties and collaborates with insurance companies, pharmacies, and Corewell Health clinics to obtain the necessary information for completing a prior… more
- Humana (Lansing, MI)
- …Certifications, CPC, CCS, CFE, AHFI) + Understanding of healthcare industry, claims processing and internal investigative process development + Experience ... hours/day, 5 days/week. **Required Qualifications** + Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of… more
- Molina Healthcare (Ann Arbor, MI)
- …of pharmacy prior authorization requests and/or appeals. + Explains Point of Sale claims adjudication , state, NCQA, and CMS policy/guidelines, and any other ... manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state… more