- Norstella (Springfield, IL)
- …offerings leveraging Norstella's unified Real World Data asset, NorstellaLinQ, a combination of claims , lab, SDOH and EMR data. You will be joining an organization ... quality. *Perform in-depth analyses on healthcare data sources, including claims , lab, EMR/EHR, and SDOH data, to uncover actionable...Plan with Company Match *Company Paid Short & Long-Term Disability *Paid Parental Leave *Paid Time Off & Company… more
- Prime Therapeutics (Springfield, IL)
- …Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of ... data + Develop financial pricing models to monitor performance against pharmacy claims data and identify financial pricing opportunities to drive savings and/or meet… more
- Prime Therapeutics (Springfield, IL)
- …Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of ... data + Develop financial pricing models to monitor performance against pharmacy claims data and identify financial pricing opportunities to drive savings and/or meet… more
- Norstella (Springfield, IL)
- …integrating diverse data sources, including laboratory data, electronic medical records (EMR), claims data, and social determinants of health (SDoH) data, to drive ... the integration of diverse data sources, including lab, EMR, claims , and SDoH data, to create comprehensive and actionable...and AD&D Benefits 401k retirement plan Short- and Long-Term Disability Paid parental leave Paid time off principles for… more
- Prime Therapeutics (Springfield, IL)
- …Education Level Bachelors + Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the United States without the ... or residency sponsorship. **Additional Qualifications** + 3+ years' fraud investigations/ claims experience. + Ability to manage workload while simultaneously working… more
- Option Care Health (Bannockburn, IL)
- …and retirement plans, including medical, dental, vision, life insurance, short term disability , long term disability , supplementary benefits, and 401(k) plan. ... corporate counsel and assists with the coordination of processes for leave, disability , and absence management programs to ensure appropriate risk management, cost… more
- R1 RCM (Chicago, IL)
- …modifier appropriateness, and LCD's/NCD's for medical necessity. + Reconciling offshore completed claims with feedback + Analyzing trends of escalated claims and ... CPC + Three (3) years of denials coding experience + Three (3) years of claims experience + Professional coding experience + Experience with Athena + Must be able to… more
- Cognizant (Springfield, IL)
- …satisfaction. **Responsibilities:** Reviewing available Appeals & Grievances for the pending claims to verify due process was followed. Determine if the appeal ... or Grievance is legitimate. A strong understanding of Claims , Appeals and Medical Benefits. Referring suspicious or complicated Claims to investigators.… more
- Elevance Health (Chicago, IL)
- …with fraud and abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities ... fraud and abuse prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately… more
- R1 RCM (Chicago, IL)
- …answer relevant questions and obtain appropriate information in pursuit of resolving unpaid claims . To thrive in this role, you must be resourceful and having ... pertaining to the EOB + Works closely with third party payers to resolve unpaid claims in proving medical necessity of the patient's admission + Works with HIM and… more