- Humana (Springfield, IL)
- …any trended claims issues stemming from internal systems issues to Provider Claims Manager and support development of systems issue resolution + Assist with ... Humana Fully Integrated Dually Eligible (HMO D-SNP) in IL, is seeking a Claims Research & Resolution Professional claims educator, who will be responsible… more
- Prime Therapeutics (Springfield, IL)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Clinical Account Manager - Georgia PDL - Remote in Georgia **Job Description** ... + Provides clinical operations input and support of client specific claims processing programs, coordinates implementations of clinical projects and programs… more
- Elevance Health (Chicago, IL)
- … documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will ... make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, ...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Chicago, IL)
- …guidelines and to identify opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to ... ** Clinical Fraud Investigator II - Registered Nurse and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Walgreens (Chicago, IL)
- …of medications and drug interaction awareness. Offers preventive and clinical healthcare services, including immunizations, diagnostic testing, and patient outcome ... (eg patient consultation, medication management, drug therapy reviews, and perform clinical , or wellness services such as immunizations, diagnostic testing, and… more
- Walgreens (Itasca, IL)
- …and federal laws/regulations allow, accountable for performing day-to-day non- clinical pharmacy operations, administrative activities; Ensures efficient pharmacy ... to customers' requests in a timely manner and answers non- clinical questions to ensure a positive customer experience. Models...efficient workflow. + At the direction of the Pharmacy Manager or pharmacist, prepares, and files reports and records… more
- Evolent (Springfield, IL)
- …ensuring accurate and timely ICD-10 coding of claims via progress note clinical documentation review . + Ensure compliance and quality for all coding ... Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Manager , Coding Support Specialist** Evolent Care Partners is seeking a Risk Adjustment… more
- AbbVie (North Chicago, IL)
- …strategies for assigned projects; for the design, analysis, and reporting of clinical and other scientific research programs; for generating scientific evidence to ... of study results. Be able to explain statistical concepts to non-statistician. + Review identified or anticipated technical or data related issues arising in the… more
- CVS Health (Rantoul, IL)
- …integration. Instructs programs and procedures in compliance with network management and clinical coverage policies. BH Case Manager is responsible for ... clinical coverage policies. - Through the use of clinical tools and information/data review , conducts an...and multiple diagnoses that impact functionality. - Reviews prior claims to address potential impact on current case management… more
- Sumitomo Pharma (Springfield, IL)
- …regulatory submissions by preparing responses to agency inquiries and contributing to labeling claims . + Review Case Report Forms (CRFs) to ensure data ... highly motivated, and experienced individual for the position of Manager of Biostatistics to serve as trial statistician for...to serve as trial statistician for one or more clinical studies. He or she works closely with the… more