- Centene Corporation (Springfield, IL)
- …various mental health settings especially inpatient behavioral health units, utilization management / review , and youth or pediatric services.** Additional ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- Highmark Health (Springfield, IL)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more