- Molina Healthcare (Sterling Heights, MI)
- …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... nursing experience with broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility… more
- Molina Healthcare (Sterling Heights, MI)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of… more
- R1 RCM (Detroit, MI)
- …working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid claims . + Apply clinical judgment and ... and underpaid claims . Every day you will review medical records to ensure appropriate coding...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + An active CCS,… more
- R1 RCM (Detroit, MI)
- …experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and payer denial information submitted by clients ... appeals.Represent clients at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
- Elevance Health (Dearborn, MI)
- …enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more
- Trinity Health (Livonia, MI)
- …and trouble shooting + Makes a manual requisition for patient orders for Registered Nurse approval during emergencies, codes and downtime. + Maintains unit ... function. + May be responsible for assuring that patient medical claim data used for billing purposes...access, retrieve and print reports from Quest/Vista. + Obtain, review and correct errors per error report(s) or upon… more