- Humana (Lansing, MI)
- …a part of our caring community and help us put health first** The Senior Claims Research and Resolution Professional reports to the Claims ... objectives, including their applications to assignments. The Senior Claims Research and Resolution Professional follows general guidance and processes… more
- Molina Healthcare (Detroit, MI)
- **Job Description** **Job Summary** Responsible for work load assignment to the provider Claims adjudicators and senior provider claims adjudicators. Train ... as well and customer services, problem solving, critical thinking skills and research and resolution skills. Strong attention to detail Strong analytical… more
- Humana (Lansing, MI)
- …of our caring community and help us put health first** The Senior Encounter Data Management Professional develops business processes to ensure successful submission ... considerable latitude in determining objectives and approaches to assignments. The Senior Encounter Data Management professional ensures data integrity for claims… more
- Humana (Lansing, MI)
- …first** Our Government Contract Requires US Citizenship for this Position. As a Senior Software Engineer, you will be an integral member of the HGB Interoperability ... work with complex systems that manage electronic health records, referrals, and claims . This position provides the opportunity to collaborate closely with team… more
- Molina Healthcare (Warren, MI)
- …and Operations areas of responsibility (eg, Provider Services/Provider Inquiry Research & Resolution , Provider Contracting/Provider Relationship Management). + ... and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system… more
- Prime Therapeutics (Lansing, MI)
- …Sr. Functional Bus Consultant (Compliance) - Remote **Job Description** The Senior Functional Business Consultant The Functional Business Consultant serves as a ... on internal and client projects, regulatory requirements, process improvement, advanced research , root cause analysis, complex issue research , documentation,… more
- Molina Healthcare (Warren, MI)
- …Operating Committee Management. May also have responsibility for provider problem research , resolution , and prevention. + Provides accountability for Delegation ... Provider Network Management and Operations Department. Works with staff and senior management to develop and implement provider contracting and service strategies… more
- Corewell Health (Grand Rapids, MI)
- …Eligible Special Needs (HIDE-SNP) Long-Term Services and Supports (LTSS) is a senior leadership role responsible for the strategic and operational oversight of ... in coordination with external partners and reports directly to the Senior Director of Utilization Management. Essential Functions Strategic Leadership & Program… more
- Cardinal Health (Lansing, MI)
- …peers, customers, and suppliers at various management levels; may interact with senior management + Interactions normally involve resolution of issues related ... and ICD-10 codes by analyzing patient medical records. + Availability to assist with research of denied claims . + Maintains a functional knowledge of enterprise… more