- Molina Healthcare (Sterling Heights, MI)
- JOB DESCRIPTION Job SummaryProvides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching ... pharmacy strategy for optimization of medication related health care... prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any… more
- Highmark Health (Lansing, MI)
- …coordination of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + ... **Minimum** + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree +… more
- SpartanNash (Fenton, MI)
- …service, utilizing the computer systems to maintain patient profiles and insurance claims , and checking out patients that ensures that the shift contributes to ... take inventory of medications (prescription and over the counter). + Notify Pharmacy Manager of supplies/products that need to be ordered. + Receive… more
- Prime Therapeutics (Lansing, MI)
- …experience, preferably leveraging AI + PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + ... levels of leadership within the organization, acting as a representative of the broader Financial Systems team + Provide...we are a different kind of PBM. We're reimagining pharmacy solutions to provide the care we would want… more
- Henry Ford Health System (Troy, MI)
- …with insurance payors regarding authorization issues. May be the hospital representative at external meetings which involve HFH management. Ensuring that services ... accuracy prior to claim submission Managing authorization related denied claims to ensure the highest rate of payment recovery...a full suite of home health offerings, virtual care, pharmacy , eye care and other health care retail. With… more
- Henry Ford Health System (MI)
- …with insurance payors regarding authorization issues. May be the hospital representative at external meetings which involve HFH management. + Ensuring that ... prior to claim submission + Managing authorization related denied claims to ensure the highest rate of payment recovery...a full suite of home health offerings, virtual care, pharmacy , eye care and other health care retail. With… more