- Prime Therapeutics (Lansing, MI)
- …reporting to the Corporate Compliance Committee (CCC) and Finance, Compliance & Audit Committee (FCA) meeting materials. + Act as a liaison between technical ... or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +...related area of study, such as Juris Doctor + Medicare Part D, Medicaid, and/or Affordable Care Act knowledge… more
- Evolent (Lansing, MI)
- …of utilization review determinations, including appeals. + Provides input into audit processes including development of questions. + Reviews statistical sample of ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Corewell Health (Grand Rapids, MI)
- …to meet program goals including but not limited to provider incentive programs, audit and compliance processes and well as EMR optimization and other technology ... initiatives through the Prospective team members via provider education, chart audit , etc. + Internal stakeholder management: ensures open communication and… more
- Trinity Health (Ann Arbor, MI)
- …payment arrangements. Obtains medical authorization or referral forms, if appropriate. Audit authorizations for accuracy and determine if delay/deny policy needs to ... of insurance and governmental programs, regulations and billing processes ( Medicare , Medicaid, Social Security Disability, Champus, and Supplemental Security Income… more
- Corewell Health (Grand Rapids, MI)
- …but not limited to clinical and operational management as well as legal, internal audit , risk management , finance and Human Resources functions . The SVP, Chief ... to the system clinical compliance team to ensure effective compliance with Medicare Conditions of Participation as evaluated by deeming agencies . . Ensures… more
- Molina Healthcare (Ann Arbor, MI)
- …MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the ... + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management… more
- Trinity Health (Howell, MI)
- …payment arrangements. Obtains medical authorization or referral forms, if appropriate. Audit authorizations for accuracy and determine if delay/deny policy needs to ... of insurance and governmental programs, regulations and billing processes ( Medicare , Medicaid, Social Security Disability, Champus, and Supplemental Security Income… more
- Humana (Lansing, MI)
- …+ Familiarity with compliance standards, Finance data governance, and system audit -readiness. **Preferred Qualifications** + MBA or other Advanced Degree + ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Humana (Lansing, MI)
- …+ Familiarity with compliance standards, HR data governance, and system audit -readiness. **Preferred Qualifications** + MBA or other Advanced Degree + Demonstrated ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Hospice of Michigan (Southfield, MI)
- …to meet regulatory requirements. + Maintains working knowledge of hospice Medicare Conditions of Participation and state-specific regulations to support compliant ... to meet regulatory standards by auditing reports from the EHR: Admission HIS Audit , Discharge HIS Report, Admission CTI Report, Recert CTI/F2F Report, Provider Order… more