- Integra Partners (Troy, MI)
- JOB OVERVIEW Our Claims Resolution Specialist role is responsible for reviewing Durable Medical Equipment (DME) claims for billing accuracy while ... documentation and account records, as well as timely issue resolution . In this role, you will ensure work is...HIPAA compliance. If you have previous medical billing or claims experience, this role may be of interest as… more
- Molina Healthcare (Warren, MI)
- JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution ... Services (CMS). **Essential Job Duties** * Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members,… more
- Molina Healthcare (Warren, MI)
- …Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members and provider (or authorized ... and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution of the appeals from Molina members, providers and related… more
- Molina Healthcare (Warren, MI)
- …for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with ... Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from… more
- Molina Healthcare (Warren, MI)
- …clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains ... audits and communicates with Core Operations Functional Business Partners to ensure resolution within 30 days of error issuance. * Evaluates the adjudication of… more
- Henry Ford Health System (Troy, MI)
- …completeness of patient financial, insurance and demographic information to ensure compliant claims are sent to payers. The Sr. Specialist works independently ... The CBO Insurance Sr. Specialist is responsible for effectively and efficiently resolving...for his/her functional area, coaching team members on account resolution workflows, and assisting the supervisor with team management.… more
- Molina Healthcare (Warren, MI)
- …and timely validation and maintenance of critical provider information on all claims and provider databases (using SQL, Excel, and QNXT). Staff ensure adherence ... areas of responsibility (eg, Provider Services/Provider Inquiry Research & Resolution , Provider Contracting/Provider Relationship Management). + Provides timely, accurate… more
- Molina Healthcare (Warren, MI)
- …for reviewing and resolving member & provider complaints and communicating resolution to members (or authorized) representatives in accordance with the standards ... and grievances. + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial letters. + Assists...**C** **E:** + 1 year of Molina experience, health claims experience, OR one year of customer service/provider service… more
- Ford Motor Company (Allen Park, MI)
- …maneuvers or during a failed battery state. **3. Quality, Reliability & Problem Resolution :** + Lead the investigation, root cause analysis, and resolution of ... testing), and formal sign-off processes. + **Quality, Reliability & Problem Resolution :** Extensive experience in leading root cause analysis, problem-solving, and … more
- Molina Healthcare (Warren, MI)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... and finance partners to proactively identify issues and implement resolution strategies. + Serves as a thought partner to...a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +… 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, ... requirements. + Performsnecessary maintenance to patient accounts in the billing and claims editing systems. + Responds timely to all patient and commercial… more