- Humana (East Saint Louis, IL)
- …the implementation of the Community Engagement Team for the Humana Illinois Medicaid Market by working collaboratively with the Health Equity, Clinical, Quality, ... and community-based visits as needed to ensure effective administration of the Medicaid program- including occasional night and weekend events **Use your skills to… more
- CVS Health (Springfield, IL)
- …quality inter-rater review audits of medical records coded by internal team (CDQA and Sr CDQA) to ensure the ICD-10 codes that are submitted to the Centers for ... Medicare and Medicaid Services (CMS) for the purpose of risk adjustment...departments and management. + Conducts process audits to ensure compliance with internal policies and procedures and existing CMS… more
- CVS Health (Springfield, IL)
- …accreditation from the National Health Care Anti-Fraud Association (AHFI) + Experience In Medicaid Compliance , Medicaid Investigations, MCO Medicaid FWA ... with contractual requirements. Coordinates and collaborates with program integrity staff, compliance , and senior leadership. Contributes to the development and… more
- CenterWell (Springfield, IL)
- …diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Program Management Lead, Offshore ... to inquiries and issues. + May participate in coder education programs on coding compliance . + Follows state and federal regulations as well as internal policies and… more
- Humana (Springfield, IL)
- …and Solutions + Clinical Operations + Medicare Divisional + Provider Experience + Medicaid **Location:** The summer internship program is remote, and all interns are ... in a Master of Business (MBA) or other advanced professional degree (eg MPH, MD, JD, Ph.D.), with a...real value. + **Executive Access & Networking:** Engage with senior leaders and peers through speaker series, fireside chats,… more
- CVS Health (Springfield, IL)
- …(eg, specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance , Legal, Accreditation) and clients. The Medical Director (Medical ... and decision making. Medical Directors represent the clinical decision making and professional thought process of the prescriber as a partner across the enterprise's… more
- Humana (Springfield, IL)
- …years' experience with stakeholder management (strategy/operations at a top-tier consulting/ professional services firm). They will have a demonstrated ability to ... concise outputs (PPT, Excel). This person must be comfortable working collaboratively with senior leaders and subject matter experts alike and should have a high… more
- Baylor Scott & White Health (Springfield, IL)
- …and senior medical staff including denials from all payers, Medicare/ Medicaid audit activities and key contract enforcement activities. + Collaborates with ... Appeal Specialists, Payer Liaisons and Collectors focused on appealing hospital and professional clinical and coding denials, as well as Recovery Audit Contractors… more
- CVS Health (Springfield, IL)
- …evaluation, and oversight of vendor relationships to ensure optimal performance, compliance , and alignment with organizational goals. This role collaborates with ... ensuring alignment with organizational objectives.** **Monitor vendor performance, ensuring compliance with contractual obligations, service level agreements, and regulatory… more
- Humana (Springfield, IL)
- …stakeholders just as much as users. **_Leadership_** + Ability to influence senior leaders, peers, and diverse teams consisting of a multitude of perspectives. ... and remove barriers for our consumers. **_Professionalism_** + Have a strong professional presence, be approachable, respectful, open, transparent, and easy to work… more