- Sedgwick (Toledo, OH)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Director Complex Claims **PRIMARY PURPOSE** **:** To be responsible for ... managing SIU investigations of complex fraud schemes involving providers, vendors, attorneys and others;...degree from an accredited college or university preferred. Fraud Claims Law Associate (FCLA), Certified Insurance Fraud Investigator (CIFI),… more
- Molina Healthcare (Ann Arbor, MI)
- …with federal and state laws. Negotiates and services larger and more complex market/national/group-based providers in accordance with company standards in order to ... expectations * Evaluates, negotiates and supports larger and more complex market/national/group-based providers in compliance with company standards while meeting… more
- Molina Healthcare (Toledo, OH)
- …contracting negotiations and understanding of alternative arrangements. Maintains critical Complex provider information on claims and provider databases. ... federal, state and local regulations. Responsible for contracting/re-contracting of Complex contracts with Alternative Payment Methods including but not limited… more
- University of Michigan (Ann Arbor, MI)
- …and UMH West. The Revenue Cycle Liaison acts under the oversight of the Senior Director for Revenue Cycle Services and reports to the Director of the Revenue ... Works with payers regarding policy changes or mishandling of claims that lead to write offs. + Provides education...Self-motivated with a willingness to take initiative and solve complex problems + Capability to negotiate with and influence… more
- ProMedica Health System (Toledo, OH)
- REPORTING RELATIONSHIPS/SUPERVISORY RESPONSIBILITIES This position reports to the Director , Professional Coding, Audit & Education has no direct reports. POSITION ... regulatory changes or updates. Reviews medical record documentation and claims data to ensure compliance with CMS and payer...Years of Experience: Minimum of 3 years of physician/professional complex surgical and E&M coding experience in a health… more