- Molina Healthcare (Ann Arbor, MI)
- … Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses ... to law enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical records to determine accuracy of … more
- Henry Ford Health System (Troy, MI)
- …issues. The CBO Coding Senior Specialist confirms the accuracy and completeness of coding to ensure compliant claims are sent to payers. The CBO Coding ... (2) years of revenue cycle experience in a large healthcare system required. + Additional specialty coding ...years college or additional course work in Accounting, Business, Healthcare Administration or Medical Record Sciences preferred.… more
- R1 RCM (Detroit, MI)
- …edit software to check bundling issues, modifier appropriateness, and LCD's/NCD's for medical necessity. + Reconciling offshore completed claims with feedback + ... of official coding conventions and rules established by the American Medical Association (AMA) (ie: Documentation Guidelines '95 & '97) For this US-based… more
- Intermountain Health (Lansing, MI)
- …Classification of Diseases ICD-10 and Diagnosis Related Groups (DRG) codes for claims concurrently while a patient is in a hospital. It ensures accurate ... codes in support of the provision of value-based care by Intermountain Healthcare to appropriate populations. It ensures compliance and accurate submission of… more
- Humana (Lansing, MI)
- …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare, Medicaid, and Medicare Advantage requirements… more
- Molina Healthcare (Ann Arbor, MI)
- …different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding /billing (UB04/1500 form) + Demonstrated understanding of key managed ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical… more
- Henry Ford Health System (Troy, MI)
- … Medical Policy Team and HAP code-related committee meetings to resolve coding questions related to claims , configuration, benefits, new technology, fraud, ... professional publications as it pertains to Benefit Administration Manual policies, claims processing decisions, and coding credentials. This posting represents… more
- Molina Healthcare (MI)
- …to reduce the likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by applying advanced clinical ... in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific… more
- Molina Healthcare (Warren, MI)
- …different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding /billing (UB04/1500 form). * Advanced understanding of key managed ... executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data… more
- CVS Health (Lansing, MI)
- …Experience in healthcare fraud, waste and abuse + Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting + Experience with data ... and is ideal for a data professional with strong coding skills in SQL and Python who can transform...skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste,… more