- Molina Healthcare (Detroit, MI)
- …participating in value-based program & contract design and implementation for marketplace, Medicaid and/or Medicare + Experience in a complex healthcare delivery ... environment, specifically with government sponsored programs, including risk revenue management, strategy, and compliance + Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of coding + Knowledge of… more
- Molina Healthcare (Detroit, MI)
- …current and future contract rate proposals. + Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of ... reimbursement changes, educate/consult the health plans on the financial impact. + Work independently to support and validate Provider Network contracting and unit cost management activities through financial and network pricing modeling, analysis, and… more
- Honor Community Health (Pontiac, MI)
- …in professional organizations. + Eligible to obtain and maintain credentials as a Medicaid and Medicare provider. + 1+ years of progressive experience as ... a Nurse Practitioner. + Experience with CPT and ICD coding. + Knowledge of and experience with electronic health records (EHR) systems. + A flexible and positive attitude + Ability to work in a fast-paced environment + Ability to create an excellent patient… more
- State of Michigan (MI)
- …years of experience 07 Please select your level of experience in following Centers for Medicaid and Medicare Services (CMS) for long-term care. + None + Less ... than 1 year of experience + 1-2 years of experience + 3-4 years of experience + 5+ years of experience 08 8. Please be aware the application review and determination of your eligibility for this position is based solely upon the information provided in your… more
- Molina Healthcare (Warren, MI)
- …is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is required + Medicaid and Duals experience ... CA DOFR, DME, capitation, Physician pricing is required. + Must have knowledge on Medicare payment methods + Experience on Hospital payment methodology & processing… more
- Molina Healthcare (Warren, MI)
- …as automated analytical as well as Reporting modules related to Quality/HEDIS for Medicaid , Marketplace and Medicare /MMP. + Analysis and reporting related to ... Interventions tracking for at least one line of business among Medicaid , Marketplace and Medicare /MMP. + 3+ Years of experience in working with increasingly… more
- Gentiva (West Branch, MI)
- …and/or Hospice Medical Director Certification Board certification preferred. + Current Medicare Provider Enrollment (PECOS) and Medicaid certification if ... + Certify and recertify hospice eligibility, ensuring timely compliance with Medicare and other regulations. + Conduct and supervise face-to-face patient visits,… more
- Molina Healthcare (Grand Rapids, MI)
- …Review tracking, Interventions tracking for at least one line of business among Medicaid , Marketplace and Medicare /MMP. * 5+ Years of experience in working ... with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics. * 5+ Years of experience in Statistical Analysis and forecasting of trends in HEDIS rates to provide analytic support for… more
- Banner Health (MI)
- …compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the ... Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards. 4. As assigned, compiles daily and monthly reports; tabulates data from medical records for research or analysis purposes. 5.… more
- Banner Health (MI)
- …compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the ... Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards. Ability to address related and complex matters independently with regard to interpretation of coding guidelines. 4. Acts as a… more