- 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
- Option Care Health (Lansing, MI)
- **Extraordinary Careers. Endless Possibilities.** **With the nation's largest home infusion provider , there is no limit to the growth of your career.** Option Care ... the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team...and more impactful. Our organization requires extraordinary people to provide extraordinary care, so we are investing in a… 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 (Grand Rapids, MI)
- …hospice agency promptly if unable to complete F2F visits as scheduled. + May provide F2F coverage for multiple provider numbers with approval. **About You** ... that offers a supportive team, flexible schedule, fleet vehicle/mileage reimbursement , comprehensive benefit package, competitive compensation and excellent work… 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
- Molina Healthcare (Grand Rapids, MI)
- …modeling current and future contract rate proposals. * Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of ... Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard. * Generate hospital performance analytics tools on a quarterly basis; develop reports on… more
- Molina Healthcare (Detroit, MI)
- …modeling current and future contract rate proposals. + Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of ... Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard. + Generate hospital performance analytics tools on a quarterly basis; develop reports on… more
- University of Michigan (Ann Arbor, MI)
- …not be submitted. Apply Now **Job Summary** **Why Join Michigan Medicine's Hospital Billing Audits & Appeals (HBAA) Department?** The Audit and Appeals Specialist ... denials. They manage and respond to Medicare, Medicare Advantage, Varis, Medicaid and other various commercial audits. The Appeals Specialist will communicate… more
- Trinity Health (Chelsea, MI)
- …exam. + Complete patient related documentation in accordance with department and hospital policy. + Study is reviewed and completed in medical record according ... of problems related to safety, sanitation and maintenance of the environment. Provide quality patient care by considering the age specific, development and cultural… more
- Molina Healthcare (Warren, MI)
- …(UB04/1500 form). * Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS ... from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions… more
- Trinity Health (Chelsea, MI)
- …of information acquired pertaining to patient, physicians, employees, and visitors. + Provide quality patient care by considering the age specific, developmental and ... largest Catholic healthcare organizations in the country + Tuition Reimbursement Click Here (http://www.trinityhealthmichigan.org/careers/working-here/) to learn more about the… more
- State of Michigan (Kalamazoo, MI)
- …Job Number 3909-20-043 Department Health and Human Services - Kalamazoo Psychiatric Hospital Opening Date 10/01/2023 Bargaining Unit UNITED AUTO WORKERS (UAW) + ... Description + Benefits + Questions Job Description The MDHHS mission is to provide opportunities, services, and programs that promote a healthy, safe, and stable… more
- Trinity Health (Chelsea, MI)
- …that may require emergency actions and initiating appropriate responses. + Provide accurate diagnostic image identification, process diagnostic images, and monitor ... largest Catholic healthcare organizations in the country + Tuition Reimbursement Click Here (https://www.stjoeshealth.org/careers/current-openings/benefits) to learn more about… more
- Trinity Health (Livonia, MI)
- …and initiates the billing process for any services provided by the hospital . As a mission-driven innovative health organization, we will become the national ... poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs. **ESSENTIAL FUNCTIONS** Responsible… more