- 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
- Molina Healthcare (Springfield, IL)
- …to refer clients who may be eligible for other Molina products. + Viewed as a " subject matter expert " (SME) by community and influencers on the health care ... promotion and advocacy. + Strong presentation skills and broad knowledge of Illinois Medicaid is helpful. **If you are passionate about community engagement and have… more
- Public Consulting Group (Springfield, IL)
- …of Medicaid waivers. **Duties and Responsibilities** + Serves as project manager and subject matter expert within the practice including management of a ... . Summary: We are seeking a senior-level, detail-oriented and self-motivated Medicaid Waiver Evaluation Consultant to join our team. This role involves… more
- Prime Therapeutics (Springfield, IL)
- …Marketplace Quality Rating System (HIM QRS). This position is also responsible to be a subject matter expert (SME) in an assigned quality area of focus, ... strategy. This role provides leadership and subject matter expertise on Medicare Stars, Medicaid quality..., Commercial/HIM); serve as primary point of contact and subject matter expert on all… 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
- CVS Health (Springfield, IL)
- …health plan. This role will be a key member of the health plan leadership as the subject matter expert 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
- 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
- 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
- CVS Health (Springfield, IL)
- …record auditing skills and abstraction expertise. + Serves as the training resource and subject matter expert to vendors, providers and other team members ... the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate,… 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
- CVS Health (Springfield, IL)
- …senior/executive management regarding federal/state regulations in the healthcare industry. Serves as a subject matter expert by providing legal advice and ... mental health parity exams. + Identifies and reviews legal risk for buisness areas/ subject matter experts for purposes of assessing market conduct impact and… 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
- 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
- Centene Corporation (Springfield, IL)
- …to promote the organization and its services to the community, while serving as the subject matter expert for the team. + Develop and implement strategies ... experience. Experience in working with government-sponsored population, especially Medicare, Medicaid and SCHIP. Experience in public speaking. Pay Range: $55,100.00… more
- Humana (Springfield, IL)
- …in evaluating benefits utilization, cost trends, and program effectiveness + Serve as the subject matter expert on all Humana personal time off policies ... 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)
- …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
- Cardinal Health (Springfield, IL)
- …Medicaid states on paper and online. + Mails all paper claims. + Acts as a subject matter expert in claims processing. + Manages billing queue as assigned ... in the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes denials & rejections for re-submission (billing) in accordance with company policy, regulations,… more