- Molina Healthcare (Warren, MI)
- …**Job Summary** Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines, ... and provider compliance. Interacts with health plans and vendors regarding recovery outstanding overpayments. **Job Duties** + Prepares written provider overpayment… more
- Henry Ford Health System (Troy, MI)
- …completeness of patient financial, insurance and demographic information to ensure compliant claims are sent to payers. The Sr. Specialist works independently ... The CBO Insurance Sr. Specialist is responsible for effectively and efficiently resolving...Information + Organization: Corporate Services + Department: CBO Insurance Recovery - HB + Shift: Day Job + Union… more
- Henry Ford Health System (Troy, MI)
- …of patient financial, insurance and demographic patient information to ensure compliant claims to Third party payers. Resolves problem accounts from payer denials ... and follows up on any claims that require a payer response. Responsible for the...Information + Organization: Corporate Services + Department: CBO Insurance Recovery - HB + Shift: Day Job + Union… more
- Molina Healthcare (Warren, MI)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... and State regulatory requirements are met for Pre-pay Edits, Overpayment Recovery which improves encounter submissions, reduces General and Administrative expenses… more
- Molina Healthcare (Warren, MI)
- …review to facilitate a referral to law enforcement or for payment recovery . **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical ... records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines,...+ AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred + Certified Fraud Examiner and/or AHFI professional… more
- Molina Healthcare (Warren, MI)
- …(specialty and ancillary) contracts highly desirable. **STATE SPECIFIC REQUIREMENTS** : Certified Recovery Peer Specialist certification required in the state of ... **_ Remote and must live in Michigan _** **Job...and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple … more