- Integra Partners (Troy, MI)
- JOB OVERVIEW Our Claims Resolution Specialist role is responsible for reviewing Durable Medical Equipment (DME) claims for billing accuracy while ... documentation and account records, as well as timely issue resolution . In this role, you will ensure work is...HIPAA compliance. If you have previous medical billing or claims experience, this role may be of interest as… more
- Sedgwick (Detroit, MI)
- …Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Sr. Claims Specialist , Veterinary Claims | Professional Liability | Remote ... PURPOSE** **:** To analyze complex or technically difficult veterinary claims ; to provide resolution of highly complex nature and/or severe injury claims… more
- Trinity Health (Livonia, MI)
- …8:30 am-5pm No Weekends w/Holiday Rotations** **Position Purpose:** The Authorization Specialist is responsible and accountable for the processing of all THAH ... and THAH Collection analysts in the tracking of authorizations and resolution of problematic billing issues. Monitors pending authorizations report and collaborates… more
- Molina Healthcare (Warren, MI)
- JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution ... Services (CMS). **Essential Job Duties** * Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members,… more
- Guidehouse (Detroit, MI)
- …remote** .Daily duties for this position include: + Responsible for the daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits ... codes and associated coding modifiers. + Responsible for daily resolution of assigned claims with Revenue Integrity specific denials in the Guidehouse METRIX℠… more
- Henry Ford Health System (Detroit, MI)
- …patient access hub workflows related to medication access, prior authorizations, and claims resolution . Collaborate with pharmacists and care teams to implement ... patients' medication access by managing infusion and injection benefit claims , ensuring financial viability, and addressing affordability concerns throughout the… more
- Sedgwick (Detroit, MI)
- …Work(R) Fortune Best Workplaces in Financial Services & Insurance ADA Accommodation Specialist **PRIMARY PURPOSE** : To enhance the ADA process for claimants ... key stakeholders regarding progress and status of accommodations; assists in the resolution of any challenges related to the accommodations. + Conducts interactive… more
- Trinity Health (Livonia, MI)
- …analyzes information. Identifies opportunities, develops solutions, & leads through resolution . Collaborates on performance improvement activities as indicated by ... & HCC risk adjustment, ensuring compliance with reporting standards for claims submission. + Identifies patterns & trends impacting documentation & coding… more
- Henry Ford Health System (Troy, MI)
- …assist patients with their medical bills via phone. We pride ourselves on one call resolution and provide career growth to those who want to excel. The hours are as ... the customer in understanding their patient responsibility. Strives for first contact resolution in a timely and efficient manner. 3. Ensures timely responses to… more
- TEKsystems (Troy, MI)
- Please see details for the opening: Job Title: Customer Claims Specialist Category: Mortgage, Insurance Pay Range: 17$/hour Location: Office - 700 Tower Drive, ... composure + Document interactions and updates thoroughly in the claims system + Demonstrate strong problem-solving and resolution... claims system + Demonstrate strong problem-solving and resolution skills + Make outbound calls as needed to… more
- Molina Healthcare (Warren, MI)
- …**Job Summary** Provides subject matter expertise for oversight, production, and resolution of health plan payment integrity (PI) recovery concepts. Executes and ... and finance partners to proactively identify issues and implement resolution strategies. * Serves as a thought partner to...a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. *… more
- McLaren Health Care (Shelby Township, MI)
- …and human resources. **BILLING:** Responsible for billing hospital and physician claims , for inpatients and outpatients treated in the hospital and clinic, ... requirements. + Performsnecessary maintenance to patient accounts in the billing and claims editing systems. + Responds timely to all patient and commercial… more
- Henry Ford Health System (Troy, MI)
- …fraud, compliance, and any other issue. Aside from committee meetings, assist with claims resolution issues as needed. + Assist in requesting and tracking ... professional publications as it pertains to Benefit Administration Manual policies, claims processing decisions, and coding credentials. This posting represents the… more
- Molina Healthcare (Warren, MI)
- …business analyses of national contracts/benefits to support accurate configuration for claims payment); Provider/Member Inquiry Research and Resolution ; and ... Provides training and guidance as needed to the Contract Managers and Contract Specialist (s). * Helps develop and utilize standardized contract templates and Pay for… more