- Prime Therapeutics (Lansing, MI)
- …and drives every decision we make. **Job Posting Title** Sr. Compliance Analyst - Remote **Job Description** The Regulatory Inquiry & Complaints Senior Compliance ... Analyst assists in the implementation of Prime's compliance programs,...stakeholders to research and resolve regulatory inquiries/complaints related to claims , contracting and pharmacy reimbursement. Works directly with business… more
- Henry Ford Health System (Troy, MI)
- …averages, comparing to Government fee schedules and analyzing existing healthcare ( claims ) data and reimbursement terms and payment methodologies; with the goal ... inpatient and high dollar outpatient payments for various payors, including MA, Medicaid and Commercial. 8. Create prospective and retrospective analyses to assess… more
- Molina Healthcare (Ann Arbor, MI)
- …etc. **PREFERRED EXPERIENCE:** + SQL expertise + Excel expertise + Medicare, Medicaid , Marketplace claims expertise **PHYSICAL DEMANDS:** Working environment is ... generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods.… more
- CVS Health (Lansing, MI)
- …abuse. + Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants and customers. + Researches and ... + Pharmacy Investigative experience + Marketplace Broker Investigative experience + Medicaid and Medicare experience **Education** + Bachelor's degree in Criminal… more
- Corewell Health (Grand Rapids, MI)
- …interviews, medical records audits, data mining, perform compliance audits of medical claims , fee screens and other payment mechanism to ensure accurate payment. + ... State and Federal laws related to fraud, waste or abuse, Medicare and Medicaid regulations, etc. + Ability to work effectively with minimal supervision and direction… more
- Molina Healthcare (Grand Rapids, MI)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... coordination, and ownership of high-value deliverables-distinct from a pure data analyst role. **Job Duties** **Business Leadership & Operational Ownership** +… more