- Highmark Health (Lansing, MI)
- …utilization management activities to ensure compliance with internal policies, state, CMS , and federal regulations . This role serves as a clinical subject ... matter expert, providing insights and guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case … more
- Intermountain Health (Lansing, MI)
- …compliance and appropriate revenue capture. + Researches and stays current on CMS , federal and state regulations , payor guidelines, ensuring compliance and ... **Job Description:** The RCO Rev Integrity Chargemaster Analyst II independently handles EPIC build, maintenance, and.... **Skills** + Epic + CPT Coding + Healthcare regulations + CMS guidelines + Communication +… more
- Molina Healthcare (Sterling Heights, MI)
- …program that effectively prevents and/or detects violation of applicable laws and regulations , which will protect the Business from liability and potential ... Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. **Knowledge/Skills/Abilities** The… more
- Corewell Health (Grand Rapids, MI)
- …functions. Qualifications Required + Bachelor's Degree or equivalent in health care, business management + 5 years of relevant experience knowledge of ... + Content expert/educator of annual cost reports in accordance with CMS & State of Michigan regulations . Maintains up-to-date knowledge of Medicare/Medicaid… more
- Corewell Health (Grand Rapids, MI)
- …monitoring programs that ensures performance metrics are achieved in compliance with CMS /HHS regulations . + Internal stakeholder management : ensures open ... and requires current knowledge of Risk Adjustment legislation and regulations to apply across the business . The...experience in data analysis and reporting, preferably as a business analyst in the health insurance industry… more