- Molina Healthcare (Sterling Heights, MI)
- …Operations teams . Interprets, communicates, and presents, clear in-depth analysis of claims research results, root cause analysis, remediation plans and fixes, ... SKILLS & ABILITIES: . 2-5 years of experience in medical claims processing, research , or a related field . Demonstrates familiarity in a variety… more
- Molina Healthcare (Sterling Heights, MI)
- …processing issues + Interprets, communicates, and presents, clear in-depth analysis of claims research results, root cause analysis, remediation plans and fixes, ... cross functionally across multiple business areas. **KNOWLEDGE/SKILLS/ABILITIES** + Provides research and analytics associated with medical claims processing… more
- Molina Healthcare (Sterling Heights, MI)
- …+ Must have experience in research , review and audits for adjudication rates of claims + Must be able to work in cross functional teams + Must have experience ... accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes… more
- R1 RCM (Detroit, MI)
- …analytics, AI, intelligent automation, and workflow orchestration. As our Denials & AR Analyst II, you will help R1 clients by analyzing claims information ... what you will experience working in Denials & AR Analyst II:** + You will be investigating and analyzing... II:** + You will be investigating and analyzing claims to identify denial reasons and create appeal letters… more
- Molina Healthcare (Sterling Heights, MI)
- …ability to work independently, self-navigate organizational and technical challenges. Performs research and analysis of healthcare claims data, pharmacy data, ... and existing health plans. + Completes analysis on retroactive claims reports + Pre and post validation of complex...Requires assistance with schema from Tech resource or Lead Analyst . + Writes Requirements for BRDs/FRDs and Reports. +… more
- Molina Healthcare (Sterling Heights, MI)
- …Description** Who you are : + You have proven experience as a QA Analyst within an Agile environment. + Experienced testing on-premise and cloud based ETL/BI ... You can prioritize. + You have experience with QNXT, claims processing , healthcare insurance and SQL + You...QA role within our Agile team is a Senior Analyst position dedicated to ensuring the highest quality standards… more
- Molina Healthcare (Sterling Heights, MI)
- **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and ... and Identifying targeted Interventions and tracking outcome. Assist with research , development, and completion of special performance improvement projects.… more
- Carhartt, Inc. (Dearborn, MI)
- …Classification: HybridFLSA: ExemptJob Band: Professional Job SummaryThe Sr. Treasury and Risk Analyst serves as a critical role, supporting senior level team members ... + Manages monthly bank reconciliation process. Resolves reconciling items through research and escalation. + Leads gathering and preparation of insurance renewal… more
- Trinity Health (Detroit, MI)
- …revenue and financial assistant teams to ensure accurate documentation and claims creation. This position is not remote **1.Abstracts inpatient and outpatient ... to JCAHO and MPRO, HEDIS and other quality measures. for research projects, quality improvement studies, statistical reporting. Responsible for quality control… more
- Molina Healthcare (Sterling Heights, MI)
- …analysis. + Works with internal, external and enterprise clients as needed to research , develop, and document new standard reports or processes. + Implements and ... to support the departments goals. + SQL, Databricks, Python + Claims knowledge/QNXT **JOB QUALIFICATIONS** **Required Education** Associate's Degree or equivalent… more
- Molina Healthcare (Sterling Heights, MI)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization ... and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. **KNOWLEDGE/SKILLS/ABILITIES** + Develop ad-hoc reports using SQL programming, SQL… more
- Molina Healthcare (Sterling Heights, MI)
- …+ Actively participates in all stages of project development including research , design, programming, testing and implementation to ensures the released product ... operational processes including but not limited to Enrollment, UM, Claims & Care Management** **Preferred License, Certification, Association** Certified Business… more
- McLaren Health Care (Shelby Township, MI)
- …tasks accurately and timely. **BILLING:** Responsible for billing hospital and physician claims , for inpatients and outpatients treated in the hospital and clinic, ... necessary maintenance to patient accounts in the billing and claims editing systems. + Responds timely to all patient...vendors in a timely and professional manner. + Notify Analyst of edits that needs to be built and… more