- Molina Healthcare (Ann Arbor, MI)
- …or discrepancies related to over- or underpayment. + Utilize QNXT to research claims history, provider contract setup, and benefits configuration. + Work ... + Assist manager in establishing peer review standards and methodology + Research and review new audit tools and techniques and provide recommendations to… more
- Molina Healthcare (Sterling Heights, MI)
- …who have Databricks experience with advanced skills in data analysis. Performs research and deep-dive analysis of complex healthcare claims data, CMS return files, ... + Converting data into usable information that is easy to understand. + Research and develop reports and analysis for senior management and effectively communicate… more
- Molina Healthcare (MI)
- …appeal into information system and prepares documentation for further review. + Research issues utilizing systems and other available resources. + Assures timeliness ... medical records, notes, and/or detailed bills as appropriate to assist with research . + Determines appropriate language for letters and prepare responses to appeals… more
- Molina Healthcare (Warren, MI)
- …Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research , analysis and modeling of complex healthcare claims data, pharmacy ... understand and provides insights needed to support strategic investment decisions + Research and develop reports and analyses for senior management and effectively… more
- Henry Ford Health System (Troy, MI)
- …but is not limited to: + Application of cash and contractual adjustments/discounts + Research and follow up of misapplied or missing payments + Timely balancing and ... storage and retention. + Timely resolution of self-pay credit balances EDUCATION AND EXPERIENCE: + Associates degree in Business Administration, Accounting, or… more
- Molina Healthcare (Detroit, MI)
- …membership cards and materials. Verify enrollment status, make changes to records, research and resolve enrollment system rejections. Address a variety of enrollment ... coordinate with Center of Excellence team as needed. **Job Qualifications** **Required Education ** Bachelor's Degree or equivalent combination of education and… more
- Henry Ford Health System (Troy, MI)
- …(SME). 7. Support the development and deployment of job aides and staff education materials and develop programs to address staff needs. 8. Participate in continuous ... develop programs to address staff needs. 11.Perform other duties as assigned. EDUCATION /EXPERIENCE REQUIRED: + High School Diploma. Bachelor's Degree in Education… more
- Molina Healthcare (MI)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... Financial and Utilization Metrics of Healthcare. **JOB QUALIFICATIONS** **Required Education ** Bachelor's Degree in Finance, Economics, Math, Computer Science; or… more
- Molina Healthcare (Grand Rapids, MI)
- …membership cards and materials. Verify enrollment status, make changes to records, research and resolve enrollment system rejections. Address a variety of enrollment ... maintenance of policies and standard operating procedures. **Job Qualifications** **Required Education ** Graduate Degree or equivalent combination of education … more
- Molina Healthcare (Detroit, MI)
- …impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the development/maintenance of Member Materials. ... provided in accordance with all State/HMO requirements.. **Job Qualifications** **Required Education ** Bachelor's Degree in Social Work, Human Services or related… more