- Molina Healthcare (Ann Arbor, MI)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring ... hospital setting, including at least 1 year of utilization review , medical claims review...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Ann Arbor, MI)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … more
- Elevance Health (Dearborn, MI)
- …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- Molina Healthcare (Ann Arbor, MI)
- …Microsoft Excel (edit/save spreadsheets, sort/filter) **Required License, Certification, Association** Licensed registered nurse ( RN ), Licensed practical ... internal policies, and contract requirements. This position completes a medical review to facilitate a referral to...corresponding medical records to determine accuracy of claims payments. + Review of applicable policies,… more
- Elevance Health (Dearborn, MI)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Elevance Health (Dearborn, MI)
- …Give referral and/or make referral appointment as circumstances warrant. + Review for medical appropriateness psychiatric/substance abuse cases utilizing ... practice that is relevant to the clinical area under review . + Provide reviews for predetermination of medical...+ Conduct business in a professional manner. + Troubleshoot claims issues. + Investigate and research to resolve customer… more
- University of Michigan (Ann Arbor, MI)
- …Care Management, Registration, MiVisit Business services, clinics and ancillary departments. + Review patient medical records and utilize clinical and regulatory ... Audit and Appeals Specialist has a strong knowledge of medical appeal and audit practices for both the inpatient...Medicare inpatient only list to ensure accurate reimbursement. + Review readmissions and apply payer guidelines. Combine accounts as… more