- Molina Healthcare (Sterling Heights, 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
- Trinity Health (Farmington Hills, MI)
- …permit to practice nursing in the assigned state. **Experience working with PB medical claims processing denials and appeals needed** **Experience working with ... Responsible for reviewing all post-billed denials (inclusive of clinical denials) for medical necessity and appealing them based upon clinical expertise and clinical… more
- Elevance Health (Dearborn, MI)
- ** Nurse and CPC - Clinical Fraud Investigator II -...control. + Review and conducts analysis of claims and medical records prior to payment. Researches ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Molina Healthcare (Sterling Heights, MI)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
- Integra Partners (Troy, MI)
- …the healthcare industry, including pre-authorization and utilization reviews, along with medical claims processing. + Proven experience in designing multiple ... Integra Partners is seeking an experienced nurse educator to join our Operations Training & Development team as an Operations UM Training Specialist, specializing in… 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