- Humana (Lansing, MI)
- …Senior Business Intelligence Engineer will develop and maintain expertise in complex Medicare reimbursement methodologies. This role is within the Integrated ... on Pricer edit resolution + Provide consultation to internal business partners on Medicare reimbursement /editing logic and Humana system logic **Use your skills… more
- Molina Healthcare (Sterling Heights, MI)
- …their financial and clinical performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **JOB ... and manage information from large data sources. + Analyze claims and other data sources to identify early signs...- 5 years supervisory experience + Demonstrated understanding of Medicaid and Medicare programs or other healthcare… more
- AmeriHealth Caritas (Detroit, MI)
- …psychosocial needs. This role ensures that care is delivered by Centers for Medicare & Medicaid Services (CMS), state, and organizational guidelines, within the ... individuals with chronic conditions or disabilities. + Strong understanding of Medicare - Medicaid Plan Long-Term Services and Supports (MMP LTSS) programs.… more
- Danaher Corporation (Detroit, MI)
- …and reimbursement landscape. + Communicate regional and local coverage and reimbursement issues for Medicare , Medicaid and Commercial payers through ... and reimbursement . + Support customers with approved resources for denied claims , payer coverage expansion and inadequate reimbursement . + Respond to and… more
- Humana (Lansing, MI)
- …certification from the AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, and ... efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large.… more
- Molina Healthcare (Warren, MI)
- …and troubleshooting. **Job Duties** + Research, review, and decipher state-specific Medicaid and Medicare reimbursement methodologies for providers, ... or reimbursement processes + Experience processing or reviewing facility claims + Prior professional experience utilizing Microsoft Excel (eg, performing basic… more
- Guidehouse (Detroit, MI)
- …regarding compliance, and reimbursement under outpatient grouping systems such as Medicare OPPS and Medicaid or Commercial Insurance EAPG's. + Knowledge and ... various types of authoritative information. + Maintains current knowledge of Medicare , Medicaid , and other third-party payer billing compliance guidelines… more
- Cardinal Health (Lansing, MI)
- …done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. They will work within the scope of responsibilities as ... and support from AR & Billing leadership teams.** **_Responsibilities_** + Processes claims : investigates insurance claims ; and properly resolves by follow-up &… more
- United Therapeutics (Detroit, MI)
- …Teams + Advanced knowledge of medical insurance terminology + Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in ... commercial teams, to develop and implement plans that optimize patient access and reimbursement . You are an expert in therapy access with an understanding of… more
- University of Michigan (Ann Arbor, MI)
- …credentialing, and privileging following the strict requirements of Centers for Medicare and Medicaid (CMS), The Joint Commission (TJC), the ... our patients and safeguard Michigan Medicine against loss of accreditation, malpractice claims , and claims of negligent credentialing. + Completes evaluation of… more