- Humana (Lansing, MI)
- …the core of this evolution is Humana's Insurance Segment, which provides Medicare Advantage, Medicaid, and other health plans to millions. By integrating insurance ... a pivotal role in defining the future of Humana's Medicare and Medicaid businesses, which generate the majority of...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Corewell Health (Grand Rapids, MI)
- …outcomes for members within the dual-eligible population. This role ensures compliance with state and federal regulations and fosters cross-functional collaboration ... LTSS. It also ensures that LTSS operations align with the integration of Medicare and Medicaid benefits under Michigan's HIDE SNP model, meeting CMS and MDHHS… more
- Humana (Lansing, MI)
- …Agency Professional; Finance & Accounting supports data analysis related to compliance and commissions for Humana's external producers. The role involves handling ... provides support for handling and analyzing data that pertains to the compliance and commissions of Humana external producers. The Senior Agency Professional;… more
- Molina Healthcare (MI)
- …complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination, ... Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay… more
- CVS Health (MI)
- …records coded by internal teams prior to the submission to the Centers of Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are ... Federal regulations and internal policies and procedures. Contributes to compliance reporting and documentation, highlighting findings, recommendations, and areas of… more
- Trinity Health (Ypsilanti, MI)
- …analysis to ensure that clinical research studies are billed in compliance with the CMS National Coverage Determination Decision, all applicable billing ... subsequently review clinical study protocol, budget and consent form to prepare a Medicare coverage analysis. + Prepare submissions to the Medicare fiscal… more
- University of Michigan (Ann Arbor, MI)
- …and accurately assigns ICD-10-CM, ICD-10 PCS, as well as assignment of the Medicare Severity Diagnosis Related Group, (MS-DRG) / All Patient Refined - Diagnosis ... on payor classification and abstracts specific data elements for each case in compliance with federal regulations. This position codes all types of inpatient records… more
- Humana (Lansing, MI)
- …of Quality Assurance Professionals responsible for ensuring consistency of use and compliance to state and Humana requirements for Long-Term Services and Supports ... professionals and Care Management Support Assistants) staff and monitors compliance with Home and Community-Based Services (HCBS) eligibility determination, service… more
- Humana (Lansing, MI)
- …statistical records and the activities of various departments to ensure compliance with the organization's policies, procedures and standards. The Director, Internal ... for planning, executing, and overseeing audit activities to ensure compliance with internal policies, regulatory requirements, and industry standards. The… more
- Molina Healthcare (Detroit, MI)
- …providers, pharmacists, pharmacies and technicians - ensuring departmental and Centers for Medicare and Medicaid Services (CMS) standards are met. * Educates Molina ... adherence. * Enforces Health Insurance Portability and Accountability Act (HIPAA) compliance standards and regulations. * Provides clerical services and support to… more