- Highmark Health (Lansing, MI)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- Corewell Health (Canton, MI)
- …information, educating and providing information as necessary. Collects and documents Medicare Questionnaire, issue Medicare Inpatient Letter & Medicare ... Performs medical necessity check and issue ABN as appropriate for Medicare primary outpatients. Note: excluding lab-only outpatients effective September. + Affix… more
- Molina Healthcare (Ann Arbor, MI)
- …and adherence to applicable timelines * Support all risk adjustment audit related projects to ensure goals, objectives, milestones and deliverables are ... met * Evaluate results from audit activities to address barriers, gaps, opportunities for improvement,...to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations and guidelines of… more
- Corewell Health (Grand Rapids, MI)
- …Manage the vendors that are hired to perform Universal program review and audit functions for Priority Health. Oversee all activities associated with delivering an ... audit service from Statement of Work (SOW) creation to...care payer + Experience working with government programs including Medicare , Medicaid and FEHB + CRT - Registered Health… more
- Banner Health (MI)
- …knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment ... information from a variety of sources. 2. Reviews medical records. Performs an audit of clinical documentation to ensure that clinical coding is accurate for proper… more
- Molina Healthcare (Sterling Heights, MI)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay ... + Manages Scorable Action Items (SAIs) related to pre-pay editing, post-pay audit , and overpayment recovery initiatives to ensure Health Plan SAI targets are… more
- Ensono (Detroit, MI)
- …US Citizenship and pass related background checks including but not limited to Medicare and Medicaid and VA **Preferred Skills:** + Experience with secure file ... transfer protocols and audit /compliance requirements. + Ability to work in a hybrid...a strong background in implementing and maintaining Centers for Medicare & Medicaid Services (CMS) security standards and compliance… more
- Prime Therapeutics (Lansing, MI)
- …internal and external distribution Compliance Committee and the Compliance and Audit Committee and supports the Chief Compliance Officer's compliance governance ... Supports new client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid) + Other duties as assigned **Education & Experience** +… more
- Molina Healthcare (Detroit, MI)
- …order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with ... and makes determinations as to whether the investigation and/or audit identified potential fraud, waste, or abuse. + Coordinates...+ Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of… more
- CVS Health (Lansing, MI)
- …with heart, each and every day. **Position Summary** + Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and ... ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of...International Classification of Disease (ICD) codes. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and… more