- CVS Health (Springfield, IL)
- …And we do it all with heart, each and every day. **Position Summary** The Medicaid Network Provider Relations Manager oversees our Medicaid ... * Minimum of 2 years' experience with Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and … more
- CVS Health (Springfield, IL)
- …audit readiness and collaborates with Compliance, Legal, Medicaid Health Plans, Network Contracting, and Provider Relations to ensure alignment with ... will also serve as a key liaison between Compliance, Legal, Network Contracting, and Provider Relations teams. **Required Qualifications** + A minimum of… more
- CVS Health (Downers Grove, IL)
- …to work with others at all levels * Minimum of 5+ years' working experience in Provider Relations or Network Strategy * Minimum 5+ years' experience in ... benefits and/or contract interpretation * Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes… more
- Humana (Springfield, IL)
- …+ Ensure compliance with all Virginia managed care contractual requirements for provider relations , such as timeframes for claims dispute resolution, ... years of health care or managed care experience working with providers (eg, provider relations , claims education). + Experience working with physical health… more
- Humana (Springfield, IL)
- …Strategy & Transformation Office + Medicare & Medicaid Market Operations + Provider Relations & Network Performance + Marketing & Customer Engagement ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Humana (Springfield, IL)
- …+ 4 or more years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience + 2 or more years of ... caring community and help us put health first** The Supervisor, Provider Engagement develops and grows positive, long-term relationships with physicians, providers… more
- Humana (Springfield, IL)
- …claims denials, rework, underpayments and claims errors. This role supports the Provider Relations team with appropriate claims submission processes and ... claims data for providers in the IL FIDE network to identify trends in denials and rework the...and corrected claims + Conduct training in collaboration with Provider Relations on claims denials, rejections or… more
- CVS Health (Springfield, IL)
- …collaboration internally and externally to support coordinated care. Partner with Plan leaders, Network , and provider relations teams to drive differentiated ... and in alignment with IL MCO landscape and Illinois Medicaid guidelines. Serve as clinical liaison to network... provider engagement/experience. Collaborate with network teams to optimize provider performance, value… more
- Humana (Springfield, IL)
- …with federal and state laws and programmatic requirements + Collaborates with Provider relations personnel to ensure high-quality and appropriate care delivered ... the development of new products and services in Humana's Medicaid BH delivery model. **Position Responsibilities:** + Leads clinical...through the BH Provider network + Establishes and maintains relationships… more
- CVS Health (Springfield, IL)
- …internal collaboration across the various functional areas (Care Management, Utilization Management, Provider Relations , Network , and Quality). In addition, ... to support the Behavioral Health needs of our ABHIL Medicaid members. The role will be the key conduit...meets the needs of vulnerable sub-populations within our Illinois Medicaid membership. Some examples include Justice Involved members, members… more
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