- Corewell Health (Grand Rapids, MI)
- …may include research, interviews, data analysis, and substantive desk or onsite medical record review. Responsible for preparing case file, final report and ensuring ... Assists with internal and external education on fraud, waste, abuse, billing and documentations requirements. Essential Functions + Responsible for investigating,… more
- Highmark Health (Lansing, MI)
- …to prevent further improper payments.Forwards case to the Credentialing and/or Medical Review Committee, law enforcement and regulatory agencies. + Responsible for ... to internal and external law enforcement and regulatory agencies, Credentialing or Medical Review Committee. + Engages in delivery of audit results and overpayment… more
- R1 RCM (Detroit, MI)
- The **Professional Services Coder ** will be responsible for reviewing clinical documentation and diagnostic results as appropriate (ie, to extract data and apply ... appropriate ICD-10-CM, HCPCS and CPT-4 codes for billing , review and correct billing edits, internal...physician assigned diagnosis code after thorough review of the medical record and, if necessary, queries physician for additional… more
- Elevance Health (Dearborn, MI)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... Related Group Clinical Validation Auditor** is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs… more
- CVS Health (Lansing, MI)
- …Certified Professional Coder (CPC) Manager will oversee a team of medical coders within the Special Investigations Unit (SIU) to ensure compliance with coding ... practices through comprehensive record reviews for medical , behavioral, transportation, and other healthcare providers. The CPC Manager will be responsible for… more
- Humana (Lansing, MI)
- …field. + Healthcare insurance industry knowledge. + Experience validating and interpreting medical record documentation to ensure billing for services is ... Manager, you will spearhead audit and validation processes to ensure medical documentation and coding are precise, compliant, and support optimal reimbursement.… more
- Humana (Lansing, MI)
- …CM guidelines + Prior experience in provider education + Strong knowledge of medical record review + Understanding of billing , claims submission, and related ... is responsible for reviewing and analyzing internal data and medical records, as well as coordinating educational sessions with...or equivalent + Must hold AAPC CPC (Certified Professional Coder ) certification + 2 years or more experience with… more
- Intermountain Health (Lansing, MI)
- **Job Description:** This position is responsible for billing , follow-up, and resolving issues that delay or prevent payment of the patient's account within ... hire. Plus one of the following certifications: Current certification as a coder through AAPC or American Health Information Management Association (AHIMA), or… more