- Prime Therapeutics (Lansing, MI)
- …specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid Services (CMS) compliance compliant + Utilize Prime's MTM ... operations (eg workflow processes and case management) + Government programs ( Medicare ) knowledge **Preferred Qualifications** + Contact Center experience + Pharmacy… more
- Corewell Health (Farmington Hills, MI)
- …motivated and reach their goals. Our Dementia Care floor is a 60 bed Medicare / Medicaid /Dementia unit. We provide care to residents with a variety of diagnoses. ... the unit Our sub-acute floor is a 59 bed Medicare unit that has residents with multiple clinical issues...satisfaction. Our Chronic Care floor is a 60 bed Medicare /Rehabilitation and long-term care unit and is a great… more
- Elara Caring (Ludington, MI)
- …branch locations to meet patient needs. + Ensures compliance of current Medicare , Medicaid , and third-party reimbursement regulations and changes. Identifies and ... : + Ensures all documentation is accurate, complete, timely and adheres to Medicare guidelines. + Assures compliance with the requirements of state licensure, … more
- Humana (Lansing, MI)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... investigations of reported, alleged or suspected fraud involving Florida's Medicaid Program. The Fraud and Waste Professional 2 coordinates investigation… more
- Humana (Lansing, MI)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... of Network Adequacy requirements and process optimization, primarily focusing on the Medicaid line of business, with a deep understanding of network build… more
- Henry Ford Health System (Troy, MI)
- …to investigate, analyze, and resolve issues at a high level. + Knowledge of Medicare , Medicaid , Medicaid OPPS reimbursement, and other third- party billing ... rules/coverage, preferred. + General understanding of the hospital revenue cycle. CERTIFICATIONS/LICENSURES REQUIRED: + Coding Credential (CPC, COC, CCA, CCS, RHIT) or Clinical Credential (RN, NP, PA) preferred. Additional Information + Organization: Corporate… more
- Humana (Lansing, MI)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... administrative expenses and quality/bonus performance + Comprehensive knowledge of Medicare policies, processes and procedures **Additional Information** This role… more
- Humana (Lansing, MI)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... Intelligence Engineer position will be supporting BI work for our Medicare organizations. **Senior Business Intelligence Engineer** : + Develops and maintains… more
- Humana (Lansing, MI)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... reporting on progress, challenges, and achievements to management. + Partner with Medicare Risk Adjustment (MRA) and vendors to establish data feeds for STARs… more
- Cognizant (Lansing, MI)
- …Director based on the review of clinical documentation in accordance with Medicare , Medicaid , and third-party guidelines. . Effectively document and log ... Reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines. . Review retro-authorizations in… more