- CVS Health (Northbrook, IL)
- …day. **Position Summary** The Corporate Medicaid Compliance team is looking for a Sr . Analyst to support the Medicaid Business Compliance Office (BCO) ... will have a successful background in supporting cross-functional projects. The Sr . Analyst will support compliance oversight of market-specific implementations… more
- Prime Therapeutics (Springfield, IL)
- …that. It fuels our passion and drives every decision we make. **Job Posting Title** Sr . AI Business Analyst - Remote **Job Description** **Are you a Business ... grow your career in the IT AI space.** The Sr . IT Business Systems Analyst (BSA) is...project team and various levels of management. With consistent Senior Leadership visibility, the IT BSA Sr … more
- Prime Therapeutics (Springfield, IL)
- …and drives every decision we make. **Job Posting Title** Sr . Compliance Analyst - Remote **Job Description** The Senior Compliance Analyst assists ... related documentation for reporting to the Chief Compliance Officer, Prime's senior leadership team, executives, Corporate Compliance Committee members and the Board… more
- Baylor Scott & White Health (Springfield, IL)
- + **JOB SUMMARY** The Risk Adjustment Analyst Sr is responsible for monitoring and oversight of the end-to-end encounter management workflow. This position ... independently and with cross functional groups.Knowledge of ACA, Medicare, Medicaid , MCO, TPA business requirements preferred.Experience with healthcare encounters,… more
- CVS Health (Chicago, IL)
- …Brief Overview** + Provide actuarial support for the **Texas and Oklahoma Medicaid ** plans. + Performs actuarial functions by applying expanded quantitative skills ... with others to meet/exceed expectations. **Preferred Qualifications** + Experience in Medicaid + Experience with SQL + Experience with PowerPoint **Education** +… more
- CVS Health (Springfield, IL)
- …internal teams prior to the submission to the Centers of Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, ... coding, and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required. +… more
- CVS Health (Chicago, IL)
- …the operational and financial performance evaluation across Aetna's Commercial and Medicaid Care Management programs to optimize the programs' performance, identify ... for building and maintaining staffing models that support the Commercial and Medicaid Care Management programs. Key responsibilities of this role include: + Build… 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...any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression,… more
- Option Care Health (Bannockburn, IL)
- …conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for ... best and brightest talent in healthcare. **Job Description Summary:** The Analyst , Compliance Auditing, Monitoring and Analytics is responsible for supporting the… more
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