- Molina Healthcare (Warren, MI)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Claims Auditing, Medical Necessity Review and Coding experience +… more
- Elevance Health (Dearborn, MI)
- …+ Travels to worksite and other locations as necessary. + BA/BS preferred. + Medical claims review with prior health care fraud audit/investigation ... you will make an impact:** + Investigates potential fraud and over-utilization by performing medical reviews via prepayment claims review and post payment… more
- R1 RCM (Detroit, MI)
- …working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid claims . + Apply clinical judgment and ... Coding Appeals Nurse ** , you will help review and interpret medical records to draft...and underpaid claims . Every day you will review medical records to ensure appropriate coding… more
- R1 RCM (Detroit, MI)
- …experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and payer denial information submitted by clients ... justified for that hospital stay or service using evidence-based guidelines. + Review governmental regulations, payer protocols, and/or medical policy to… more
- Molina Healthcare (Warren, 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
- Molina Healthcare (Warren, 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
- R1 RCM (Detroit, MI)
- …prior leadership experience in medical record reviews and extensive knowledge of medical coding for inpatient and outpatient claims , as well as reimbursement ... experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines...coders and coding team members who conduct a comprehensive review of coding denials and formulate appeals based on… 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