- WelbeHealth (Lansing, MI)
- …growth drivers + Assist with month-end close, quarterly financial reporting, financial audit , Medicare /Medicaid audits, and other PACE specific projects + Keep ... payment model, including ability to track and analyze revenue streams (eg Medicare , Medicaid, Part D) along with PACE rates and regulatory constructs **Job… more
- Humana (Lansing, MI)
- …other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how ... participate in meetings involving care management, provider relations, quality of care, audit , grievance and appeal and policy review. The Behavioral Health Medical… more
- Molina Healthcare (Grand Rapids, MI)
- …from regulatory agency through analysis and response to findings. * Organize audit submissions, interact directly with auditors for all lines of business as ... of internal corrective action plans (CAPs) for both internal and external audit findings via coordination of responses to assure appropriateness as it relates… more
- Molina Healthcare (Ann Arbor, MI)
- …durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements. You'll begin as a senior ... related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with CMS CTM… more
- Molina Healthcare (Sterling Heights, MI)
- …Data Validation) team, assisting in the execution of CMS and internal audit activities. This position contributes to the development of chart retrieval chase ... gain exposure to end-to-end RADV workflows and contribute to meaningful audit readiness efforts. **Knowledge/Skills/Abilities** + Assist with the identification and… more
- Humana (Lansing, MI)
- …expertise and passion for accuracy will make a meaningful impact. As the Nurse Audit Manager, you will spearhead audit and validation processes to ensure medical ... of all relevant coding. + Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management. + Applies clinical… more
- Fresenius Medical Center (Ann Arbor, MI)
- …options: + Educates on the availability of alternative insurance options (ie, Medicare , Medicaid, Medicare Supplement, State Renal programs and COBRA). + ... + Discusses insurance options when insurance contracts are terminated. Responsibilities involving Medicare and Medicaid include but are not limited to: + Determining… more
- Highmark Health (Lansing, MI)
- …risk activities, including but not limited to internal and external audit progress, recurring risk and compliance reporting, mandated training, investigations, and ... of managed care operations, compliance program structures, information security and audit methodologies. The incumbent must also have a foundational understanding of… more
- Henry Ford Health System (Troy, MI)
- …fraud and abuse prevention and control. + Performs medical record audits including audit of claims, rate tables, fee screens, and other payment mechanisms to ensure ... root cause analysis and submit recommendations for appropriate change management when audit findings do not reflect accurate payments (ie, over or underpayment… more
- Trinity Health (Livonia, MI)
- …Health & Human Services (DHHS) - Office of Inspector General (OIG), Centers for Medicare & Medicaid Services (CMS), Department of Justice (DOJ) as well as input ... clinical documentation & coding reviews. Must possess working knowledge of Medicare & third-party payer regulations and demonstrated knowledge & understanding of… more