- Molina Healthcare (Sterling Heights, MI)
- …functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution. Validates data received ... support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains...claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to… more
- Molina Healthcare (Sterling Heights, MI)
- … 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...information into the claim payment system and other applicable systems . + Participates in defect resolution for assigned component… more
- Trinity Health (Livonia, MI)
- **Employment Type:** Full time **Shift:** **Description:** Responsible for the data capture, analysis & reporting information to assist the Trinity Health leadership ... & expertise in the program, services & applications. Trinity Health Senior Coding Compliance Specialist Assists management in conducting annual, periodic and… more
- Elevance Health (Dearborn, MI)
- … data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health… more
- Elevance Health (Dearborn, MI)
- ** Senior Test Lead - Pharmacy Benefit Manager (PBM)** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and ... a strong, clinical-first lens to deliver member-centered, lasting pharmacy care. The ** Senior Test Lead (Business Change Manager Senior )** will be responsible… more
- Integra Partners (Troy, MI)
- …of healthcare claims processing, billing, adjudication, EDI, clinical information systems , big data , and other such systems . Business/Operational ... next steps required. Working closely with the CEO and senior leadership team, the CIO is responsible for maintaining...for the organization. Create a Scalable, Compliant, and Secure Data and IT Infrastructure The CIO will be responsible… more
- R1 RCM (Detroit, MI)
- …hospitals and systems to review and test Medicare bad debt claims for Medicare reimbursement. **Responsibilities:** + Analyze and interpret patient accounts for ... management services which transform and solve challenges across health systems , hospitals and physician practices. Our mission is to...ready for their review prior to submitting to the manager/ senior manager. Working as a part of the Government… more