- Molina Healthcare (MI)
- …and QA custom health plan reports related to Risk and Quality/HEDIS for Medicaid , Marketplace and Medicare/MMP * Develops custom health plan reports related to ... as automated analytical Reporting modules related to Quality/HEDIS for Medicaid , Marketplace and Medicare/MMP. **JOB QUALIFICATIONS** **Required Education** Bachelor's… more
- Prime Therapeutics (Lansing, MI)
- …pharmaceutical manufacturers, with specific emphasis on Medicare Part D and Managed Medicaid . The Sr Director, Pharm Trade Relations leads a team of directors ... Trade formulary strategies for Commercial, Exchange, Medicare Part D and/or Medicaid template formularies, including items such as manufacturer and GPO negotiation,… more
- University of Michigan (Ann Arbor, MI)
- …denials. They manage and respond to Medicare, Medicare Advantage, Varis, Medicaid and other various commercial audits. The Appeals Specialist will communicate ... accounts as necessary prior to release of claims. + Monitor Medicaid retrospective eligibility cases, complete required forms, track retrospective authorizations or… more
- Humana (Lansing, MI)
- …Language) to oversee reusable language frameworks across Insurance, Medicare Advantage (MA), Medicaid , CenterWell, and B2B segments. This role will lead from the ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Prime Therapeutics (Lansing, MI)
- …Management organization, or within a highly regulated industry, including experience with Medicare, Medicaid , and the Affordable Care Act (ACA) + Must be eligible to ... in related area of study, such as Juris Doctor + Medicare Part D, Medicaid , and/or Affordable Care Act knowledge and experience **Physical Demands** + Ability to… more
- J&J Family of Companies (Grand Rapids, MI)
- …and affordability solutions across multiple payer types and plans (ie, Medicare, Medicaid Managed Care, Commercial). + Execute business in accordance with the ... payer approval processes and business acumen. + Understanding of Medicare, Medicaid , and private payer initiatives affecting reimbursement of pharmaceutical and… more
- Cardinal Health (Lansing, MI)
- …licenses and coordinates the full cycle onboarding and enrollment into Medicaid , Medicare, and the commercial insurance plans. + Establish policies, procedures, ... billing and collections. + Strong knowledge of the rules/regulations of Medicare/ Medicaid and other government payors, as well as commercial insurers and… more
- Henry Ford Health System (Troy, MI)
- …analyze, and resolve issues at a high level. + Knowledge of Medicare, Medicaid , Medicaid OPPS reimbursement, and other third- party billing rules/coverage, ... preferred. + General understanding of the hospital revenue cycle. CERTIFICATIONS/LICENSURES REQUIRED: + Coding Credential (CPC, COC, CCA, CCS, RHIT) or Clinical Credential (RN, NP, PA) preferred. Additional Information + Organization: Corporate Services +… more
- Humana (Lansing, MI)
- …flexibility in care manager's schedule. **Duties:** + Telephonically assess Medicare, Medicaid , and/or and Group Account members and create actionable and measurable ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Humana (Lansing, MI)
- …Research, Health Policy, Information Technology, or another relevant field. + Previous Medicaid or Managed Care experience. + Bilingual or multilingual in Spanish, ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more