- Humana (Lansing, MI)
- …our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business ... the Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support… more
- AmeriHealth Caritas (Southfield, MI)
- …partnership with & incentives for providers. + Ensure strategic alignment with state Medicaid agenda and compliance with provider related aspects of state ... preferred. + 10 or more years of experience years of managed care provider contracting and reimbursement experience, including in-depth knowledge of … more
- Guidehouse (Detroit, MI)
- …and third party payer accounts that are subject to pre-bill claim edits, hospital billing scrubber bill hold edits, and claim denials. **This position is 100% ... for charge reconciliation audits + Escalate departments noncompliant with policy and provide action plan when needed + Responsible for the daily resolution of… more
- Humana (Lansing, MI)
- …- 5 years of experience in negotiating managed care contracts with physician, hospital and/or other provider contracts. + Proficiency in analyzing, understanding ... part of our caring community and help us put health first** The Provider Contracting Professional 2 initiates, negotiates, and executes dental provider contracts… more
- Molina Healthcare (Sterling Heights, MI)
- …and/or functional requirements related to but not limited to coverage, reimbursement , and processing functions to support systems solutions development and ... **JOB DUTIES** + Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to… more
- Henry Ford Health System (Troy, MI)
- …practices focusing on revenue cycle integrity. The RI Specialist understands hospital payor contracts and reimbursement methodologies. Works collaboratively with ... Integrity staff to identify charge system weakness, recommends changes, provide education, and tracks utilization. Due to its service...issues at a high level. + Knowledge of Medicare, Medicaid , Medicaid OPPS reimbursement , and… more
- Gentiva (Okemos, MI)
- …hospice agency promptly if unable to complete F2F visits as scheduled. + May provide F2F coverage for multiple provider numbers with approval. **About You** ... supportive team, flexible weekday schedule, competitive compensation and mileage reimbursement . **Key Responsibilities:** + Perform and complete physical assessments… more
- State of Michigan (MI)
- …survey and certification activities on behalf of the Centers for Medicare and Medicaid Services (CMS). The health care surveyor position performs surveys for covered ... (LTC) providers, specifically nursing homes, county medical care facilities, and hospital long term care units. The position conducts onsite, initial certification… more
- Henry Ford Health System (Detroit, MI)
- …interdisciplinary teams. Knowledge of CMS, commercial payer requirements and hospital financial/ reimbursement processes desired. Excellent written/verbal ... years MSW Case Management in a large acute care hospital setting. GENERAL SUMMARY: The Case Manager SW provides...required. Knowledge of child and adult protection laws, state Medicaid guidelines, NASW code of ethics (professional standards), and… more
- Oracle (Lansing, MI)
- …focus more on patient care by reducing administrative burden of clinical and reimbursement tasks such as charting, documentation, and coding by applying power of ... opportunities to prevent future denials, and ensure maximum appropriate reimbursement . This role is critical for financial recovery and...on experience preparing appeals for claim denials in the hospital and ambulatory setting + 3+ years hands on… more