- Molina Healthcare (Sterling Heights, MI)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals… more
- Arab Community Center for Economic and Social Serv (Dearborn, MI)
- Intake & Customer Service Specialist Department: Community Health & Research Center Location: Dearborn, MI START YOUR APPLICATION ... (https://apply.hrmdirect.com/resumedirect/ApplyOnline/Apply.aspx?req\_id=2891944&source=2891944-CJB-0) Job Title: Intake and Customer Service Specialist Job Status: Full-time Job Summary: Under general supervision,… more
- Molina Healthcare (Sterling Heights, MI)
- …**Job Summary** Molina's Provider Contracting function provides guidance, signature support services, standards and resources to help Molina Healthcare successfully ... terms and maintain positive relationships. * Provides national contracts support for other Molina departments/functions, including: Provider Services (and activities… more
- Trinity Health (Livonia, MI)
- …Inpatient health records utilizing encoder software and consistently uses online tools to support the coding process and references to assign ICD codes, MS-DRG, APR ... the coding process, to assess the presence of clinical evidence/indicators to support diagnosis code and MS-DRG, APR DRG assignments to potentially decrease denials.… more
- Trinity Health (Livonia, MI)
- …Interprets, researches and resolves claim edits that occur after coding to support timely final claims submission. Assigns appropriate code(s) by utilizing coding ... (PBS) teams, when needed, to help resolve billing, claims, denial and appeals issues affecting reimbursement. Maintains CEUs as appropriate for coding credentials as… more