- Highmark Health (Lansing, MI)
- …applications of Generative AI (GenAI) and Agentic AI within the healthcare payer domain. The intern will work alongside AI Engineers, Data Scientists, Product ... and Generative AI techniques, assessing their applicability to core healthcare payer operations (eg, utilization management, claims processing, member services). 3.… more
- Wolters Kluwer (Lansing, MI)
- …a solid understanding of risk adjustment in the Healthcare Technology space, experience with Payer , Provider, and Vendor, and be a true hunter, as this role covers ... equivalent experience + Experience in the healthcare technology space either in payer , provider, or vendor. + Experience working with risk adjustment software. +… more
- Cognizant (Lansing, MI)
- …Integration, User Experience, and Case Management. If you bring experience in the Payer domain, you'll add valuable insight to our solution delivery. **In this role, ... attention to detail. **These will help you stand out:** + Experience in the Payer domain. + Familiarity with Agile practices. + Ability to mentor peers and document… more
- Select Medical (Battle Creek, MI)
- …an ICU or post-surgical stay by utilizing your strong clinical background, payer knowledge, and problem-solving skills. + Perform clinical assessments of referred ... to create a smooth pre-admission and transfer process through removing payer -related and operational barriers for patients getting into our highly effective… more
- CenterWell (Lansing, MI)
- …identify educational opportunities. + Conduct research as needed. + Participate in Payer calls/chart reviews. + May participate in provider education programs on ... guidelines, healthcare regulations (including HIPAA, state and federal compliance), and payer requirements + Proficiency in Microsoft Office Suite (Word, Excel,… more
- Grifols Shared Services North America, Inc (Detroit, MI)
- …the complex dynamics affecting the industry trends * Understanding of US payer market dynamics and how managed care organizations make decisions across commercial ... and public channels * Knowledge across multiple market access channels including payer , PBM, IDN, distribution, specialty pharmacy, GPOs * Working knowledge of… more
- Henry Ford Health System (Detroit, MI)
- …compliant and optimized reimbursement in accordance with state, federal, and payer requirements. + Charge Description Master (CDM) Oversight: Collaborate with ... revenue integrity, or financial analytics strongly preferred. + Knowledge of payer billing requirements, coding standards (HCPCS, NDC, CPT), and compliance… more
- Tenet Healthcare (Detroit, MI)
- …as necessary. Remains current on external agency regulations and assists with third party payer appeals as needed. Acts as a resource person and educator to other ... relationship to admission criteria, continued stay criteria, medical necessity criteria, payer regulations and discharge planning. Functions as a resource regarding… more
- United Therapeutics (Detroit, MI)
- …center / HUB services, market access, and/or other matrix field partners. Serve as the payer expert for a defined geography and communicate payer changes to key ... stakeholders in a timely manner. + Ensure understanding of the reimbursement process, specialty pharmacies, field reimbursement services, and UT's patient support program. Advise on patient level reimbursement issues in compliance with policies and… more
- Baylor Scott & White Health (Lansing, MI)
- …team of Registered Nurses, Certified Coding Specialists, Complex Appeal Specialists, Payer Liaisons and Collectors focused on appealing hospital and professional ... teams in a complex healthcare environment + Strong understanding of payer denial codes, appeal strategies and regulatory frameworks. + Familiarity with… more