- Molina Healthcare (MI)
- …accordance with the standards and requirements of Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Responsible for the comprehensive ... coordination of benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of… more
- Molina Healthcare (MI)
- …with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Manages team responsible for the ... Anesthesia, high-dollar complicated claims, COB and DRG/RCC pricing). * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of… more
- McLaren Health Care (Detroit, MI)
- …/ completion. Communications include but are not limited to inquiries from billing company, email, Parknet messaging, calendar, Team Leader Summary, etc. * Perform ... of activities that support daily office operations, including Parknet Service Tickets, billing messages, error reports, etc. * Review and analyze reports such as… more
- CVS Health (Lansing, MI)
- …state, federal and company requirements are met and recognize any concerning billing patterns or trends. Activities include: - Conduct a comprehensive medical record ... review to ensure billing is consistent with medical record. - Provide detailed...- Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state… more
- Gentiva (Grand Rapids, MI)
- …Ensure all clinical documentation meets standards to support medical practice and billing compliance. + Monitor and report on palliative medicine quality measures ... and self-motivation. + In-depth knowledge of palliative medicine principles, Medicare/ Medicaid regulations, value-based care, and interdisciplinary processes. + Meets… more
- Humana (Lansing, MI)
- …investigations of reported, alleged or suspected fraud involving Florida's Medicaid Program. The Fraud and Waste Professional 2 coordinates investigation ... Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Understands department,… more
- Molina Healthcare (Ann Arbor, MI)
- …with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Enters denials and requests for ... Qualifications** * Customer/provider experience in a managed care organization ( Medicaid , Medicare, Marketplace and/or other government-sponsored program), or medical… more
- Molina Healthcare (MI)
- …+ 3-5 years' experience in healthcare industry, preferably in the Medicaid Managed Care Programs + Previous healthcare marketing and/or grassroots/community outreach ... experience + May require specialized skills such as claims or billing **Required License, Certification, Association:** Must have valid driver's license with good… more
- CVS Health (Lansing, MI)
- …state, federal and company requirements are met and recognize any concerning billing patterns or trends. **Activities include:** + Conduct a comprehensive medical ... review findings. + Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc.… more
- Henry Ford Health System (Jackson, MI)
- …years of revenue cycle experience including but not limited to billing , registration/insurance verification, point of service collection related experience is ... Internet. + EPIC experience preferred. + Comprehensive knowledge of state and government billing standards as it relates to insurances for but not limited to, Motor… more