- Humana (Springfield, IL)
- …a part of our caring community and help us put health first** The Senior Fraud and Waste Professional conducts investigations of allegations of fraudulent and ... abusive practices. The Senior Fraud and Waste Professional work assignments...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Humana (Springfield, IL)
- …and help us put health first** Are you a detail-driven, logic-oriented professional who thrives on translating complex marketing strategies into actionable data ... solutions? We're looking for a Senior Associate, Data Manager to join our team and...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Humana (Springfield, IL)
- …in both traditional machine learning and emerging generative AI technologies. As a Senior Engineer, you will play a key role in developing and deploying innovative ... related field) with a minimum of 5 years of professional experience; OR + Master's Degree in a similar...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Humana (Springfield, IL)
- …and help us put health first** We are looking for a highly capable Senior Data Scientist to support advanced AI initiatives focused on generative AI, embeddings, and ... + Databricks certifications (eg, Data Engineer Associate, Machine Learning Professional , Generative AI Engineer Associate). + Familiarity with ServiceNow data… more
- Cardinal Health (Springfield, IL)
- …payment posting, denial resolution, and responding to patient inquiries in a professional and timely manner. **_Responsibilities:_** + Review aging reports and work ... coding, posting and front office teams to resolve account issues + Ensure compliance with HIPAA and all relevant federal/state payor regulations. + Flag trends or… more
- CVS Health (Springfield, IL)
- …Tracking Database audits + Support audits out of QNXT and PRMS to support Medicaid SOC and SOX controls + Coordinate with applicable reporting areas as needed to ... candidate location and commutable distance to office.** **Required Qualifications** + 5+ years compliance and/or audit experience in SOC and SOX controls + 5+ years… more
- Option Care Health (Bannockburn, IL)
- …to summarize and communicate complex findings effectively. Reporting to the Senior Manager, Compliance Auditing, Monitoring and Analytics, this individual ... Medicaid reimbursement. + Experience evaluating information to determine compliance with policies, standards, laws, and regulations. + Intermediate level… more
- CenterWell (Springfield, IL)
- …State Department of Health, Federal, and local agencies. + Oversee and manage Medicaid and Medicare enrollment, renewal, and compliance activities. + Track ... seeking a detail-oriented and experienced Home Health Facility Licensure & Regulatory Compliance Analyst to join our team. The successful candidate will oversee… more
- Humana (Springfield, IL)
- …us put health first** Job Description Summary The Community Management Professional builds visibility and credibility of the organization's products and services ... of the Community Engagement Team for the Humana Illinois Medicaid Market by working collaboratively with the Health Equity,...Spanish and English + Ability to communicate effectively to senior leadership, team members, and with the community +… more
- Humana (Springfield, IL)
- …Description Summary Humana Gold Plus Integrated is seeking a Quality Improvement Professional to implement quality improvement programs for all lines of business ... description, work plan, and annual evaluation. The Quality Improvement Professional performs quality investigations to implement and support quality improvement… more