- Molina Healthcare (Detroit, MI)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- Molina Healthcare (Detroit, MI)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- Elevance Health (Dearborn, MI)
- …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- CVS Health (Detroit, MI)
- …And we do it all with heart, each and every day. **Case Manager Registered Nurse ** WFH Flexible This role will be 25-50%% travel within **Wayne or Macomb Countie** ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...member's overall wellness. + Uses clinical tools and information/data review to conduct an evaluation of member's needs and… more
- Trinity Health (Livonia, MI)
- …processes and audits, and clinical billing. Strong understanding of various medical claim formats. Knowledge of clinical documentation improvement processes ... Private payer regulations. Performs coding functions, including CPT, ICD-10 assignment, documentation review and claim denial review Responsible for proofing… more
- Molina Healthcare (Detroit, MI)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Molina Healthcare (Detroit, MI)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Elevance Health (Dearborn, MI)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
- Trinity Health (Livonia, MI)
- …and equipment for unit function. + May be responsible for assuring that patient medical claim data used for billing purposes accurately reflects the clinical ... Health Livonia continues to offer the latest in quality health and medical services. Trinity Health Livonia has received numerous awards recognizing excellence in… more
- Morley (Farmington Hills, MI)
- …management to ensure financial accuracy + **Weekly tasks:** Staffing requests; review budgets and checklists + **Program development:** + Provide operational support ... your total compensation package. **_Health & Wellness Benefits_** + Medical and prescription coverage, including free annual physicals +...+ Teladoc: 24/7 online access to doctors + 24/7 nurse help desk + Patient advocacy: Free 24/7 help… more
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