- DATAMAXIS (Springfield, IL)
- …distance (3 - 5 Hours) of Springfield, IL. Functional Description: This position is a Medicaid Subject Matter Expert for the Illinois Enterprise Data ... Provide direction, guidance and recommendations supporting decision making for large Medicaid data warehouse implementation and operations. * With the specialized… more
- Humana (Springfield, IL)
- …requires an in-depth evaluation of variable factors. This position serves as a subject matter expert for Humana's strategies supporting physician practice ... and approaches to assignments. Position will serve as a subject matter expert (SME) for...Recognition programs across multiple lines of business (Medicare and Medicaid ). + Utilizes complex SQL, SAS, and other technical… more
- Prime Therapeutics (Springfield, IL)
- …maintenance of regulatory requirements throughout the enterprise. This position acts as the subject matter expert on applicable regulations, training, and ... customer needs with business goals. + Consults with business areas and other subject matter experts to identify compliance requirements, assess risks, and… more
- Humana (Springfield, IL)
- …attending required conferences and also create content to lead/teach/present for individual subject matter contribution + Passionate about contributing to an ... submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services. They will have regular… more
- Public Consulting Group (Springfield, IL)
- …for OCM Plan, and execution of the plan as lead advisor * Operate independently as a lead and Subject Matter Expert * Lead a team of OCM, and non SME team to ... + Business Solutions + Project Assurance An OCM consultant will provide expert support and guidance to clients ensuring projects meet objectives by increasing… more
- Evolent (Springfield, IL)
- …do not initially meet medical necessity guidelines or require further evaluation by a subject matter expert . + Conduct peer-to-peer discussions with treating ... both part-time and full-time options available.** **What You'll Do:** + Provide expert reviews for cardiovascular cases, serving as a specialty-matched expert … more
- Prime Therapeutics (Springfield, IL)
- …and organize information into clear, accurate and effective executive reports + Serves as subject matter expert within Compliance and develops solutions to ... or PBM organization, or other highly regulated industry, including experience with Medicare, Medicaid , and the Affordable Care Act (ACA) + Must be eligible to work… more
- Humana (Springfield, IL)
- …responsible for supporting the Stars strategy within Insurance Operations, serving as a subject matter expert for Stars-related initiatives, and ensuring ... Principal coordinates, implements, and manages oversight of the company's Medicare/ Medicaid Stars Program for aligned areas. The Stars Improvement Principal… more
- Oracle (Springfield, IL)
- …Review, case management, and healthcare quality preferred **Responsibilities** + **Act as subject matter expert (SME):** Provide expertise for Claim ... features of Oracle Health Clinical AI Agent (CAA). This role leverages expert clinical judgment and regulatory knowledge (eg, medical necessity, level of care,… more
- Evolent (Springfield, IL)
- …aligned with value and quality outcomes** . + Support clinical reviewers as a subject matter expert and resource. + **Practice & Physician Engagement** ... delivery** . + Not under sanction or exclusion from Medicare/ Medicaid programs. To ensure a secure hiring process we...comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use… more
- Evolent (Springfield, IL)
- …when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert . . Discusses determinations (peer to peer phone ... state or federal health care program, including Medicare or Medicaid , and is not identified as an "excluded person"...comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use… more
- Evolent (Springfield, IL)
- …when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert . + Provides clinical rationale for standard and ... state or federal health care program, including Medicare or Medicaid , and is not identified as an "excluded person"...comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use… more
- Evolent (Springfield, IL)
- …when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert . + Discusses determinations (peer to peer phone ... state or federal health care program, including Medicare or Medicaid , and is not identified as an "excluded person"...comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use… more
- Humana (Springfield, IL)
- …aggressively growing our eCommerce acquisition channel. + Provide strategic thought-leadership as a subject matter expert within Enterprise Growth and with ... and milestones. **Use your skills to make an impact** **Required Qualifications** + Expert Digital experience (web, mobile, social and ecommerce) + 7+ years of… more
- Cardinal Health (Springfield, IL)
- …for physicians and staff regarding coding insufficiencies. + Serves as institutional subject matter expert and authoritative resource regarding federal, ... using a risk-based approach in planning and executing audit plans. + Expert -level knowledge and application of Medicare/ Medicaid documentation and coding rules… more
- Humana (Springfield, IL)
- …against unfilled strategic security capabilities to drive business priorities + Act as a subject matter expert on the implementation and capabilities of ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more
- Prime Therapeutics (Springfield, IL)
- …visible to executives and across the organization. **Responsibilities** + Collaborate as a subject matter expert (SME) with underwriters, other areas of ... in a healthcare organization or PBM + Previous experience pricing Commercial, Medicare or Medicaid lines of businesses + 5 years of experience in SAS, SQL, or VBA… more
- Cardinal Health (Springfield, IL)
- …in related personnel documentation as required, necessary, or appropriate. + Acts as a subject matter expert in claims processing. + Processes claims: ... secondary insurance company when necessary. + Bills supplemental insurances including all Medicaid states on paper and online. + Oversees appeals and denials… more
- CenterWell (Springfield, IL)
- …information resource for any hard revenue generation issues or system issues. Basically the subject matter expert . + Assure the completion and coordination ... + Coordinate, review, and analyze documentation and data entry supporting Medicare, Medicaid , and commercial payer requirements to ensure accurate and timely billing… more
- Humana (Springfield, IL)
- …and provides recommendations to senior executives on matters of significance, and as an advanced subject matter expert , competent to work at very high levels ... are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal… more