- CenterWell (Springfield, IL)
- …our caring community and help us put health first** The Manager of Pre -Bill Audit provides strategic leadership and operational oversight for the organization's ... pre -billing function. This role is responsible for ensuring all claims are audit-ready prior to release, driving standardization across branches, and delivering… more
- Humana (Springfield, IL)
- …claims in accordance with TRICARE policy requirements. This role involves reviewing pre -payment, high dollar claims to assess payment accuracy and identify ... **Become a part of our caring community and help us put health first** The Claims Risk Management Professional is responsible for ensuring payment quality of … more
- Humana (Springfield, IL)
- …and grows positive, long-term relationships with physicians, providers and healthcare systems. The Provider Engagement Professional (LTSS) roles and responsibilities ... including, where necessary, collaboration with appropriate enterprise business teams (ex., claims payment, prior authorizations & referrals). + Work with internal… more
- Humana (Springfield, IL)
- …years' advanced experience developing complex SQL queries + 1+ years' experience in Healthcare related data ie. Provider, Insurance, etc. + Experience with pharmacy ... claims data + Advanced knowledge of Excel (ex. Pivot...provide work visa sponsorship for this role._** Work at Home /Remote Requirements **Work-At- Home Requirements** + To ensure… more
- Evolent (Springfield, IL)
- …Codes, CPT Codes, RVUs, bundled payments, etc. + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... **What You'll Be Doing:** + Lead in-depth analyses of healthcare data - including authorizations, claims , membership,...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
- Humana (Springfield, IL)
- …escalations. **Use your skills to make an impact** **WORK STYLE:** Remote/Work at Home . While this is a remote position, occasional travel to Humana's offices for ... certification experience utilizing coding guidelines by reading and interpreting claims + Exceptional understanding of Centers for Medicare &...hours are 8AM - 5PM Eastern time. **Work at Home Requirements** * At minimum, a download speed of… more
- Oracle (Springfield, IL)
- …MS Excel, MS Word + Highly desirable to have: + Experience using EHR and/or healthcare claims data + Familiarity with Python or other programming language At ... **Evidence Generation Lead/Snr Research Consultant, RWE, Health Outcomes** **Remote/Work from home ** Oracle Life Sciences is seeking a qualified health outcomes… more
- Nestle (Schaumburg, IL)
- …worker's compensation claims + Maintain confidential medical records to include pre -employment medical exams and drug screening process + Provide a range of ... in Spanish **SKILLS & EXPERIENCE:** + Experience with Workers' Compensation claims management + Experience with OSHA recordkeeping and maintaining OSHA logs… more
- Evolent (Springfield, IL)
- …seamlessly with diverse teams and stakeholders. + Deep understanding of healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including ... preferred. + 10+ years of analytics & reporting experience in healthcare , including medical economics, cost/utilization analysis, and membership trend reporting. +… more
- Evolent (Springfield, IL)
- …to ensure clean and consistent tracking of Evolent's covered membership and claims + Synthesize complex analyses into succinct presentations for communication to key ... of Actuaries credentials with Group Health track **(Preferred)** + Familiarity with healthcare claim processing **(Preferred)** + 5+ years experience at payer or… more