- ChenMed (Eastpointe, MI)
- …+ Prescribes medication and treatment in accordance with patient condition, payer coverage/guidelines and industry standards. + Reviews PCP requests for external ... cardiology referrals and participates in delegated utilization authorizations; determines level of urgency of follow-up, referral/consultation appointments. + May have responsibility for cardiology clinical operations of 2-5 centers in the market, under the… more
- Henry Ford Health System (Troy, MI)
- …ICD-10-CM coding and guidelines. + Knowledge of medical billing and third-party payer regulations. + Knowledge of CMS programs, processes, risk adjustment payment ... methodology, and payment principles. + Knowledge of anatomy, physiology, pathophysiology, disease processes, medical terminology, pharmacology, and coding systems. + Experience with computer software programs such as Microsoft Office products, Adobe Pro, and… more
- Otsuka America Pharmaceutical Inc. (Lansing, MI)
- …+ Strong understanding of the US & Global healthcare landscape, including payer and policy environments + Excellent communication, leadership, and project management ... skills + Strong understanding of pharmaceutical compliance and regulatory frameworks + Excellent communication and interpersonal skills, with the ability to influence cross-functional teams + Strong analytical and problem-solving skills to address complex… more
- Trinity Health (Farmington Hills, MI)
- …and follow-up activities. Adheres to proactive practices which includes contacting the payer directly for payment due on accounts and reviewing and responding to ... all mail correspondence in a timely and accurate manner. Communicates with appropriate hospital departments to clarify billing discrepancies, and obtain demographic, clinical, financial, and insurance information. Performs all follow-up functions which… more
- Amgen (Detroit, MI)
- …of our products to medical professionals and helping them navigate the complex payer environment. We are actively searching for a Senior Specialty Representative to ... deliver on our commitment to serve patients. The Senior Specialty Representative acts as the primary customer contact and is responsible for implementing marketing strategy and promoting Amgen products as led by the District Manager. Responsibilities include:… more
- Trinity Health (Chelsea, MI)
- …that patients meet financial requirements including Medicare medical necessity, payer pre-certifications & referrals. Provides general information to hospital users, ... patients, families & physician offices. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of analytical reports. Incorporates basic knowledge of Trinity Health… more
- Henry Ford Health System (Jackson, MI)
- …Working knowledge/experience in utilization management, managed care, and payer issues preferred. CERTIFICATIONS/LICENSURES REQUIRED: State of Michigan Social ... Worker license if applicable. Additional Information + Organization: Henry Ford Jackson Hospital + Department: MH - General Adult Unit + Shift: Day Job + Union Code: Not Applicable Additional Details This posting represents the major duties, responsibilities,… more
- Henry Ford Health System (Clinton Township, MI)
- …Ford Macomb Hospital (HFMH) inpatient resources including appropriateness of admissions, payer grids, patient status assignments, and continued stays of inpatients. ... EDUCATION/EXPERIENCE REQUIRED: MD or DO. Two (2) years of physician advisor and/or utilization management experience. Medical Staff membership in good standing at Henry Ford Macomb Hospital (HFMH) or attainment of membership following job initiation.… more
- Datavant (Lansing, MI)
- …and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, and coding workflow operations reviews. In this ... role, you will offer meaningful information tailored to exceed customer expectations, actively identifying and presenting solutions for customer issues. This role is fully remote with a flexible schedule, allowing you to help shape the future of healthcare… more
- Trinity Health (Livonia, MI)
- …charging processes & audits, & clinical billing Working knowledge of third-party payer rules & requirements, computer operations & electronic interfaces related to ... charge documentation, capture & billing is required. Knowledge of charge capture, reconciliation, error management operations & overall revenue cycle operations required. **Additional Qualifications (nice to have)** Registered Nurse, strongly preferred… more
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