- Humana (Lansing, MI)
- …reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment. Begins to influence department's ... payment integrity, or healthcare data analytics, preferably within a managed care or payer environment. + Advanced proficiency in data mining tools (ie Power BI) and… more
- Henry Ford Health System (Detroit, MI)
- …information to ensure compliant claims to Third party payers. Resolves problem accounts from payer denials and follows up on any claims that require a payer ... + Understand and resolves third party rejections using the payer and the billing systems + Utilize various resources...payers if necessary. + Stay current with knowledge of payer and regulatory changes. + Department liaison for assist… more
- McLaren Health Care (Port Huron, MI)
- …management process including level of care, medical necessity, and third-party payer requirement. 5. Documents in the electronic medical record (EMR): clinical ... reviews (medical necessity), payer authorizations, avoidable days, readmission risks, continued stay reviews...Milliman, etc. 6. Facilitates peer to peer reviews with payer /providers. 7. Actively participates in clinical case review/rounds with… more
- CVS Health (Lansing, MI)
- …and managing the accurate and timely filing of claims within payer function group. **Additional responsibilities of the Accounts Receivable Supervisor include:** ... PFS activities + Monitor and strive to continually improve the collection of payer claims in accordance with the respective contract + Assist management with… more
- Trinity Health (Livonia, MI)
- …primary outpatients. Provides cost estimates. Collects and documents Medicare Secondary Payer Questionnaire (MSPQ) and obtains information from the patient if third ... (ie, worker's compensation, motor vehicle accidents and any other applicable payer ). Maintains operational knowledge of regulatory requirements and guidelines as… more
- Norstella (Lansing, MI)
- …etc.) across multiple brands and Market Access functions (Insights & Analytics, Payer Marketing, Field Teams, Contracting/Rebating, etc.). CSMs are the face of MMIT ... Access domain expertise (deep understanding of current and future payer trends; intimate knowledge of Payer , PBM,...and future payer trends; intimate knowledge of Payer , PBM, and IDN organization structures and offerings; understands… more
- Guidehouse (Detroit, MI)
- …efficient review and timely resolution of assigned Medicare and third party payer accounts that are subject to pre-bill claim edits, hospital billing scrubber ... + Maintains current knowledge of Medicare, Medicaid, and other third-party payer billing compliance guidelines and requirements. + Other duties commensurate with… more
- US Physical Therapy (Plymouth, MI)
- …root causes and taking corrective action. + **Track claim errors, denials, and payer patterns** to identify trends and proactively prevent future issues. + **Work ... a timely manner. + Maintain up-to-date knowledge of insurance regulations, payer requirements, and CPT/ICD-10 coding. + Communicate professionally with patients and… more
- Henry Ford Health System (Detroit, MI)
- …denial management, and collections. Ensure compliance with state, federal, and payer requirements to optimize reimbursement and financial outcomes. Collaborate with ... access hub providing seamless patient access, minimize claim denials, and resolve payer issues for infusion and injection therapies. + Data Analytics & Business… more
- Trinity Health (Livonia, MI)
- …collaboration with clinical departments, Patient Business Service (PBS) center, Payer Strategies, Compliance and other revenue cycle departments to continuously ... identified revenue enhancement opportunities. Maintains an understanding of regulatory and payer changes. Special note for Physician Billing Denials Prevention -… more