- CVS Health (Springfield, IL)
- …Explains member's rights and responsibilities in accordance with contract. Processes claim referrals, new claim handoffs, nurse reviews, complaints ... Assists in preparation of complaint trend reports. Assists in compiling claim data for customer audits. Determines medical necessity, applicable coverage provisions… more
- CVS Health (Springfield, IL)
- …monthly invoices in accounting system. + Enter and process monthly fee claims for ancillary product offerings via claim system. **Required Qualifications** ... (high school diploma or GED + 2 years of relevant experience). **Anticipated Weekly Hours ** 40 **Time Type** Full time **Pay Range** The typical pay range for this… more
- CVS Health (Springfield, IL)
- …can sit anywhere in the United States, but must work East Coast hours **_** **Position Summary** We are seeking a highly analytical and detail-oriented Data Analyst ... investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate...to non-technical audiences. + 2+ years experience interpreting medical claim data + Advanced experience in SQL & Python… more
- Carle Health (Urbana, IL)
- …improve revenue cycle activities for prior authorizations, documentation, billing and claims . Understands regulatory and third party payer guidelines for admissions, ... in denials reduction efforts, timely filing expectations for registration and authorization claim error resolution, and serves as a SME (Subject Matter Expert) for… more
- Humana (Springfield, IL)
- …including, where necessary, collaboration with appropriate enterprise business teams (ex., claims payment, prior authorizations & referrals). + Work with internal ... resources and systems (eg, claims , reimbursement, provider enrollment) to provide Exceptional Experience in...provider offices and Humana locations.** + **Core Workdays & Hours :** Typically, 8-5 pm Monday - Friday Central Standard… more
- Sedgwick (Springfield, IL)
- …Adjusting **PRIMARY PURPOSE** **:** Completes non-complex projects related to claims operations including field, desk and estimating software activities; networks ... management. Projects may involve various specialty practice areas of claims such as engineering, forensic accounting, and fire investigation....up to 100 pounds and drive up to 4 hours per day. Must have continual use of manual… more
- CVS Health (Springfield, IL)
- …And we do it all with heart, each and every day. **Position Summary** **Working hours :** **Monday through Friday between the hours of 7** **:00am to 6:00pm ... including co-morbid and multiple diagnoses that impact functionality. - Reviews prior claims to address potential impact on current case management plan. -… more
- Sedgwick (Springfield, IL)
- …Insurance Marine Investigator **PRIMARY PURPOSE** **:** To perform detailed admiralty claims investigation and analysis through examination of the loss, collection ... + Runs and interprets formal background checks related to claims through online resources, evaluating the results as it...100 pounds + Ability to drive up to 4 hours per day **Auditory/Visual** **:** Hearing, vision and talking… more
- Huron Consulting Group (Chicago, IL)
- …and MS-DRG, APR DRG assignments to potentially decrease denials. * Works Inpatient claim edits and may code consecutive/combined accounts to comply with the 72-hour ... Patient Financial Services (PFS) teams, when needed, to help resolve billing, claims , denial and appeals issues affecting reimbursement. * Maintains CEUs as… more
- Sunrise Senior Living (Park Ridge, IL)
- …internal business controls. + Process and manage unemployment and worker's compensation claims and update claim activity as necessary. + Clearly communicate ... laws/provincial labor/labour laws, and Sunrise timekeeping policies in recording/punching hours worked. + Process payroll and follow established business processes… more