- CenterWell (Lansing, MI)
- …our caring community and help us put health first** The Manager of Pre -Bill Audit provides strategic leadership and operational oversight for the organization's ... pre -billing function. This role is responsible for ensuring all claims are audit-ready prior to release, driving standardization across branches, and delivering… more
- Humana (Lansing, MI)
- …claims in accordance with TRICARE policy requirements. This role involves reviewing pre -payment, high dollar claims to assess payment accuracy and identify ... **Become a part of our caring community and help us put health first** The Claims Risk Management Professional is responsible for ensuring payment quality of … more
- Humana (Lansing, MI)
- …+ Previous encounter submissions experience + Prior internship or experience in healthcare data management, claims processing, or actuarial services + Working ... knowledge of Microsoft SQL or SAS + Understanding of healthcare encounter data and basic knowledge of claims submission and reconciliation processes. + Strong… more
- Humana (Lansing, MI)
- …Excel (pivot tables, VLOOKUP, formulas) + Familiarity with Medicaid systems, claims platforms, and reconciliation tools **Work-At- Home Requirements** + At ... existing Medicaid business processes, with a focus on eligibility, enrollment, claims , and compliance workflows. This role develops sustainable, repeatable, and… more
- University of Michigan (Ann Arbor, MI)
- …apply payer guidelines. Combine accounts as necessary prior to release of claims . + Monitor Medicaid retrospective eligibility cases, complete required forms, track ... and document all contacts, including outcomes to assure appropriate payment of claims for approved services. Document all denied services, appeal dates and maintain… more
- Humana (Lansing, MI)
- …escalations. **Use your skills to make an impact** **WORK STYLE:** Remote/Work at Home . While this is a remote position, occasional travel to Humana's offices for ... certification experience utilizing coding guidelines by reading and interpreting claims + Exceptional understanding of Centers for Medicare &...hours are 8AM - 5PM Eastern time. **Work at Home Requirements** * At minimum, a download speed of… more
- Evolent (Lansing, MI)
- …seamlessly with diverse teams and stakeholders. + Deep understanding of healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including ... preferred. + 10+ years of analytics & reporting experience in healthcare , including medical economics, cost/utilization analysis, and membership trend reporting. +… more
- Evolent (Lansing, MI)
- …to ensure clean and consistent tracking of Evolent's covered membership and claims + Synthesize complex analyses into succinct presentations for communication to key ... of Actuaries credentials with Group Health track **(Preferred)** + Familiarity with healthcare claim processing **(Preferred)** + 5+ years experience at payer or… more
- Henry Ford Health System (Troy, MI)
- …the findings of their investigations and resolution. + Perform case pre -analysis; including procuring appropriate medical records and supporting documentation prior ... duties as assigned. EDUCATION/EXPERIENCE REQUIRED: + Associate degree in healthcare or a related field. + Minimum of three...+ Minimum of two (2) years of experience reviewing Claims . + Must have successful experience with business writing… more