- Evolent (Lansing, MI)
- …mission. Stay for the culture. **What You'll Be Doing:** **Manager, Coding Support Specialist ** Evolent Care Partners is seeking a Risk Adjustment Coding Support ... Adjustment coding team members, including coding support specialists. + Provides leadership, management , and ongoing training to Risk Adjustment coding support… more
- Prime Therapeutics (Lansing, MI)
- …systems, particularly those that may be in use in a Pharmacy Benefit Management setting ( Claims Processing, Prior Authorization, Telephony, Membership, etc.). + ... drives every decision we make. **Job Posting Title** Business Intelligence Specialist - Sacramento, California market **Job Description** Delivers against business… more
- Molina Healthcare (Warren, MI)
- …the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to ... credentialing database necessary for processing of recredentialing applications. * Reviews claims payment systems to determine provider status, as necessary. Ongoing… more
- Mondelez International (Farmington, MI)
- …interfaces monitoring, track and trace, claims management , invoice management , compliance execution (HSE, quality, risk management ), tenders support, ... and external (third-party logistics vendors) business partners to ensure effective management , timely solutions and execution. You will also be responsible for… more
- Molina Healthcare (Ann Arbor, MI)
- …the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to ... credentialing database necessary for processing of recredentialing applications. * Reviews claims payment systems to determine provider status, as necessary. *… more
- Banner Health (MI)
- …and billing codes. Works with clinical documentation improvement and quality management staff to: align diagnosis coding to documentation to improve the ... Assists in creating a department-wide focus of performance improvement and quality management . Assists and participates with management through committees to… more
- Henry Ford Health System (Detroit, MI)
- …operation, working with one or more of the following areas: Utilization Management , Claims , Pharmacy Operations, Compliance, FDR oversight activities, Quality ... with the Department Work Plan and other audits identified by Compliance Management ; Reviews documentation and coding to ensure compliance with all Federal and… more
- Highmark Health (Lansing, MI)
- …analytical and communication skills Preferred + Associate's Degree + 3 years with claims processing and data management + Past auditing and strong ... areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in… more
- Trinity Health (Livonia, MI)
- …Present on Admission (POA), as well as Severity of Illness (SOI) & Risk of Mortality (ROM) indicators for Inpatient records. Identifies Hospital Acquired Conditions ... Patient Business Services (PBS) teams, when needed, to help resolve billing, claims , denial, and appeals issues affecting reimbursement. 10. Maintains CEUs as… more