- Molina Healthcare (Detroit, MI)
- …and prepares written response to incoming provider reconsideration request is relating to claims payment and requests for claim adjustments or to requests from ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance… 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
- CDM Smith (Lansing, MI)
- …40509BR **Business Unit:** FSU **Job Description:** The Disaster Program Delivery Specialist : * Collects, coordinates and/or reviews applicant data to determine ... needed throughout the program delivery process. * Supports the claims process by reviewing and validating damage details, scopes...and make recommendations to FEMA as to whether the claim is eligible. Assists with the development of the… more
- CVS Health (Lansing, MI)
- …monthly invoices in accounting system. + Enter and process monthly fee claims for ancillary product offerings via claim system. **Required Qualifications** ... each and every day. **Position Summary** The **Senior Accounts Receivable Specialist ** prepares accounting and financial records and reports, including general… more
- CVS Health (Lansing, MI)
- …measuring and monitoring the quality and effectiveness of work processes in claim processing and customer service that impact customer satisfaction, medical ... both routine and non-routine business support tasks for the Sr Quality Specialist area under limited supervision, referring deviations from standard practices to… more
- Sedgwick (Grand Rapids, MI)
- …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of ... disability. + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made… more
- Henry Ford Health System (Troy, MI)
- … coding (facility and professional), related medical terminology, use of medical records, billing claim forms, and federal and state regulations related ... SUMMARY: Reporting to the Manager, Revenue Integrity, the Revenue Integrity Specialist identifies revenue opportunities and works collaboratively with Revenue Cycle… more
- Henry Ford Health System (Detroit, MI)
- …Campus, Centralized Pharmacy Services Center - Detroit Schedule: Full Time The Pharmacy Specialist is a pharmacist who, by virtue of knowledge gained through special ... expert in a major area of pharmacy practice. The Pharmacy Specialist assumes overall leadership responsibility in directing the pharmacy-related activities in… more
- Henry Ford Health System (Troy, MI)
- …workflows, and assisting the supervisor with escalated issues. The CBO Coding Senior Specialist confirms the accuracy and completeness of coding to ensure compliant ... claims are sent to payers. The CBO Coding Senior Specialist works independently to resolve complex diagnostic accounts. The CBO Coding Senior Specialist helps… more
- Molina Healthcare (MI)
- JOB DESCRIPTION Provides support for claims activities including reviewing and resolving **Provider No Surprises Act** cases in accordance with the standards and ... ensure that internal and/or regulatory timelines are measured correctly. * Researches claims using support systems to determine **Provider No Surprise Act** cases… more