- WelbeHealth (Lansing, MI)
- ** Claims Audit Analyst ** At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option (PACE) to the most ... Services team helps ensure excellent care delivery for our participants, and the Claims Audit Analyst plays a pivotal role in ensuring timely and accurate… more
- Molina Healthcare (Detroit, MI)
- …and the Affordable Care Act (ACA). + Medical Coding certification. + Strong Medical Claims Audit knowledge To all current Molina employees: If you are interested ... to support systems solutions development and maintenance for Medical Claim Audit . This role includes coordination with stakeholders and subject matter experts… more
- Molina Healthcare (Grand Rapids, MI)
- …Responsible for accurate and timely auditing of critical information on claims databases. Maintains critical auditing and outcome information. Synchronizes data ... among operational and claims systems and application of business rules as they...and in accordance with unit standards. **Knowledge/Skills/Abilities** * Trains audit staff on configuration functionality, enhancements and updates. *… more
- Molina Healthcare (Sterling Heights, MI)
- …Description** **Job Summary** Provides lead level support as a highly capable business analyst who serves as a key strategic partner in driving health plan financial ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- Molina Healthcare (MI)
- **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and ... develops reporting solutions to assist HEDIS audit , rate tracking, and Identifying targeted Interventions and tracking...and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality… more
- Molina Healthcare (Sterling Heights, MI)
- …care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of ... claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate… more
- Highmark Health (Lansing, MI)
- …with a general understanding of data flows from various corporate systems (eg, claims , billing, lab, and Rx), to solve complex issues and problems. A comprehensive ... include but not limited to, review/editing of content submissions and best practices, audit reports, etc. The incumbent is expected to make major contributions to… more