- Huron Consulting Group (Chicago, IL)
- …and pricing rules are accurately interpreted and reflected in our claims payment environment. **Key Responsibilities** + Configure and optimize provider pricing ... test adjudication and reconciling variances. + Partner with Provider Contracting, Claims , Finance, and IT teams to support new contract implementations and… more
- Humana (Springfield, IL)
- …**Required Qualifications** + Bachelors Degree + Minimum of 3 years of medical claims auditing experience (interpreting if claims initially paid correctly in the ... Payment Integrity (formally known as Financial Recovery) experience + CAS claims knowledge + Prior vendor relationship experience/knowledge + Intermediate knowledge… more
- Cognizant (Springfield, IL)
- …: 2-3 years in healthcare revenue cycle. + **Education** : HS Diploma. Associate or bachelor's degree preferred. + **Technical Skills** : Proficiency in Excel, payer ... portals, and claims clearinghouses. + **Accounts Receivables** : AR follow up...office **These will help you stand out** + **Examine Claims ** : Analyze denied and underpaid claims … more
- Humana (Springfield, IL)
- …community and help us put health first** Own and manage Medicaid claims analytics dataset using Databricks. Ensure data accuracy, completeness, and readiness to ... data transformations, automation, and enhancements. Conduct in-depth analysis of healthcare claims to identify data issues and optimization opportunities. Work with… more
- Highmark Health (Springfield, IL)
- …the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code submission, analysis of the ... of effective Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a review of medical documentation,… more
- Zurich NA (Schaumburg, IL)
- …bill litigation, research, and resolve issues by working with corporate law, Technical Claims and other, as necessary. + Prepare, attend and participate in any ... sharing technical knowledge. + Protect Zurich's reputation by keeping claims information confidential. + Maintain professional certifications and technical knowledge… more
- Otsuka America Pharmaceutical Inc. (Springfield, IL)
- …and external regulations. This position reports directly to the Associate Director, CNS Scientific Communications. **Job Description** **Key Responsibilities ... **Core Content Development** + Under the guidance of the Associate Director, Medical Communications, draft and maintain high-priority, foundational scientific… more
- Sysco (Lincoln, IL)
- …product complaints with potential for food safety issues and to support the Claims Process with Sysco's 3rd party claims administrator. Frequently interacts with ... Operations to collect data for Sysco's legal team during claims issues to ensure relevant purchase and sales records...School or GED Equivalent Required. In lieu of an associate or bachelor's Degree, a combination of education and… more
- Humana (Springfield, IL)
- …certification from the AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, and HCPCS + ... or business-related field + Knowledge of internal Medical Coverage Policies and Claims Payment Policies + CAS claims processing experience + Experience… more
- Humana (Springfield, IL)
- …encompasses critical functions including care coordination, quality measurement, billing, claims processing, and customer service, each essential to delivering a ... operational knowledge of core functional areas (care coordination, quality, billing, claims , and customer service). + Collaborate with each Insurance Operations… more