- Molina Healthcare (Detroit, MI)
- …is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The ... reviews of previously denied cases in which a formal appeals request has been made or upon request by...and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare… more
- Molina Healthcare (Detroit, MI)
- …and other stakeholders as needed to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. * Educates and works with ... claims payment); Provider/Member Inquiry Research and Resolution; and Provider/Member Appeals and Grievances. * Coordinates with Corporate and Business Development… more
- Trinity Health (Livonia, MI)
- …(PBS) teams, when needed, to help resolve billing, claims, denial and appeals issues affecting reimbursement. Maintains CEUs as appropriate for coding credentials as ... coding and reimbursement Federal, State and local laws and regulations, the Compliance Accountability Program, Code of Ethics, as well as other policies and… more
- Trinity Health (Livonia, MI)
- …(PBS) teams, when needed, to help resolve billing, claims, denial, and appeals issues affecting reimbursement. 10. Maintains CEUs as appropriate for coding ... coding and reimbursement Federal, State and local laws and regulations, the Compliance Accountability Program, Code of Ethics, as well as other policies and… more
- Trinity Health (Livonia, MI)
- …(PBS) teams, when needed, to help resolve billing, claims, denials and appeals issues affecting reimbursement. Exhibits awareness of health record documentation or ... of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and… more