- Trinity Health (Livonia, MI)
- **Employment Type:** Full time **Shift:** **Description:** ** Claims Analyst ** **Location:** Trinity Health PACE Corp Michigan, Livonia, MI **Status:** Full time ... HYBRID, will work in the office each Wednesday. **Position Purpose:** The Claims Analyst is responsible for analyzing and reviewing claims for accuracy,… more
- Deloitte (Detroit, MI)
- …who wants to work in a collaborative environment? As an experienced Epic Billing and Claims Senior Analyst you will have the ability to share new ideas and ... * Certified in Epic Hospital Billing Administration/Professional Billing Administration and Claims * Experience in performing configuration changes and system builds… more
- Molina Healthcare (Detroit, MI)
- **Job Description** **Job Summary** Serves as claims subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are ... appropriately applied. Manages and leads major claims projects of considerable complexity and volume that may be initiated through provider inquiries or complaints,… more
- Molina Healthcare (Detroit, MI)
- **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and consultation to the Clinical Center of Excellence, Health Plan, and ... and manage information from large data sources + Analyze claims and other data sources to identify early signs...+ Provide data driven analytics to Clinical COE, Finance, Claims , Medical Management, Network, and other departments to enable… more
- Molina Healthcare (Detroit, MI)
- **JOB DESCRIPTION** **Job Summary** This Sr. Analyst , Healthcare Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment ... team. Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data… more
- Molina Healthcare (Detroit, MI)
- **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- Molina Healthcare (Detroit, MI)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... support for finance, pricing and actuarial functions + Healthcare Analyst I or Financial/Accounting Analyst I experience...functions + Healthcare Analyst I or Financial/Accounting Analyst I experience desired + Multiple data systems and… more
- Molina Healthcare (Detroit, MI)
- **Job Description** **Job Summary** Sr. Analyst , Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and ... affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable… more
- Molina Healthcare (Detroit, MI)
- **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and ... Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS… more
- Walbridge (Detroit, MI)
- Overview The Opportunity We have an exciting opportunity for a skilled Cost Analyst to join the Walbridge team. In this role you will manage a portfolio of ... + Cost Impact Analysis:Review and analyze cost impacts associated with contract claims , incentives, and penalties as well as assessing the financial implications of… more
- Molina Healthcare (Detroit, MI)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... that provider information is loaded accurately to allow for proper claims processing, outbound reporting and directory processes. **JOB QUALIFICATIONS** **Required… more
- Molina Healthcare (Detroit, MI)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting,… more
- Molina Healthcare (Detroit, MI)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of… more
- Molina Healthcare (Detroit, MI)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting,… more
- Molina Healthcare (Detroit, MI)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of… more
- Molina Healthcare (Detroit, 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** + Uses existing software and systems to support the… more
- Molina Healthcare (Detroit, 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 Server… more
- McLaren Health Care (Shelby Township, MI)
- …and human resources. **BILLING:** Responsible for billing hospital and physician claims , for inpatients and outpatients treated in the hospital and clinic, ... Performsnecessary maintenance to patient accounts in the billing and claims editing systems. + Responds timely to all patient...and insurance companies to resolve bill/claim edits. + Notify Analyst of edits that needs to be built and… more
- Molina Healthcare (Detroit, MI)
- …staff for mentoring, coaching, and analysis questions. + Reviews Medical Economics analyst work products to ensure accuracy and clarity. + Reviews regulatory ... or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of SQL… more
- Trinity Health (Livonia, MI)
- …Term Disability, Military Leave, Family Medical Leave and Workers' Compensation claims with internal areas of expertise and external vendors.Acts independently to ... years of progressive experience with increased responsibility in a Disability Analyst /Coordinator/Specialist or support role, in a high-volume work environment or an… more