• Senior QNXT Analyst - Contract Configuration

    Molina Healthcare (Albuquerque, NM)
    …payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is ... in the implementation and conversion of new and existing health plans. + Must have experience in Contracts configuration...**Required Experience** 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims … more
    Molina Healthcare (10/01/25)
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  • Credentialing Representative

    Highmark Health (Santa Fe, NM)
    …Provider File systems. + Experience with the Customer Service inquiry system or claims processing concepts. **Knowledge, Skills and Abilities** + Good written ... by telephone or in writing to obtain additional information while processing their enrollment applications. + Screen incoming applications and paperwork for… more
    Highmark Health (09/06/25)
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  • Senior Coordinator, Collections

    Cardinal Health (Santa Fe, NM)
    …to patient care + Consults with appeals department for disputed / denied claims . + Works / Understands electronic claim interchange + Understands life cycle of ... primary and secondary claims + Maintains front office support relationship + Takes...accomplishing related results as needed. + Ensures that all processing and reporting deadlines are consistently achieved. + Perform… more
    Cardinal Health (09/15/25)
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  • Claim Audit Quality Specialist

    CVS Health (Santa Fe, NM)
    …plan documents. + Knowledge of Microsoft Excel. **Preferred Qualifications** + 1-2 years claims processing experience. + 1-2 years auditing experience. + Able to ... At CVS Health , we're building a world of health...The Quality Specialist will audit pre and post payment claims for accuracy and eligibility transactions. They will also… more
    CVS Health (10/16/25)
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  • Pharmacy Coordinator

    Highmark Health (Santa Fe, NM)
    …+ High school diploma or GED + Experience in pharmacy prescription claims processing /submission/payment. **Preferred** + Associate degree + Pharmacy technician ... Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. The incumbent… more
    Highmark Health (10/16/25)
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  • Lead Analyst, Payment Integrity - REMOTE

    Molina Healthcare (Roswell, NM)
    …and tests assumptions through data, but leads with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... who serves as a key strategic partner in driving health plan financial performance. This role focuses on identifying...operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to… more
    Molina Healthcare (09/28/25)
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  • Estimator -- Mid-Level

    APTIM (Santa Fe, NM)
    …Xactimate) preferred. + A minimum of five (5) years of combined experience in claims or case processing roles, including customer service, data entry, reviewing, ... **Summary:** The Mid-Level Estimator supports the claims review process by generating accurate cost assessments for disaster-related property damage. This role… more
    APTIM (08/12/25)
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  • Manager, Healthcare Analytics - Health Plan…

    Molina Healthcare (Las Cruces, NM)
    …or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of ... plans as well as project work plans to meet reporting needs of the Health Plan. Resource to HCS staff for mentoring, coaching, and analysis questions. Responsible… more
    Molina Healthcare (10/04/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Las Cruces, NM)
    …appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing . + Identifies and reports quality of care issues. + ... work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. **Job Summary** Utilizing clinical knowledge and experience,… more
    Molina Healthcare (09/06/25)
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  • Senior Data Scientist

    Cardinal Health (Santa Fe, NM)
    …business problems on large data sets, integrating multiple systems. At Cardinal Health 's Artificial Intelligence Center of Excellence (AI CoE), we are pushing the ... + Act as a champion for AI within Cardinal Health , influencing the direction of our technology roadmap and...of healthcare data, including clinical data, patient demographics, and claims data. Understanding of HIPAA and other relevant regulations,… more
    Cardinal Health (09/06/25)
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