- Walgreens (Las Cruces, NM)
- …enhancements to pharmacy systems to further promote productivity. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent ... privacy, generics, less expensive medicines, over-the-counter products, and refers to medical provider as needed to ensure medication is taken correctly, health… more
- Highmark Health (Santa Fe, NM)
- …analytical and communication skills Preferred + Associate's Degree + 3 years with claims processing and data management + Past auditing and strong ... related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding,… more
- CVS Health (Santa Fe, NM)
- … processing and customer service that impact customer satisfaction, medical cost management, and operational efficiency. Consults cross-functionally with other ... 2+ years of experience working with diagnosis codes and medical terminology. + Moderate to advanced knowledge of Excel...and decision making skills + College degree preferred + Claims experience + DG experience **Education** + High School… more
- Public Consulting Group (Santa Fe, NM)
- …+ Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + ... provides a range of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave,...provides a range of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave,… more
- Evolent (Santa Fe, NM)
- …at Evolent will serve as a point of contact for processing prior authorization requests in accordance with departmental policies, regulatory requirements, ... also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our...prior authorization requests and/or relevant health care experience in claims or appeal & grievances is required. + Ability… more
- Highmark Health (Santa Fe, NM)
- …(AHFI) **SKILLS** + Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency + Must ... to prevent further improper payments.Forwards case to the Credentialing and/or Medical Review Committee, law enforcement and regulatory agencies. + Responsible for… more
- Walgreens (Albuquerque, NM)
- …pharmacy errors and the Continuous Quality Improvement Program. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent ... payment rejections. Follows-up with insurance companies as well as medical providers and conducts or participates in 3rd party audit. + Assists and supports Store… more
- Cardinal Health (Santa Fe, NM)
- …knowledge of healthcare data, including clinical data, patient demographics, and claims data. Understanding of HIPAA and other relevant regulations, preferred. + ... working with cloud platforms like Google Cloud Platform (GCP) for data processing , model training, evaluation, monitoring, deployment and support preferred. + Proven… more
- 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 ... for strategic analysis, profitability, financial analysis, utilization patterns and medical management. + Interfaces and maintains positive interactions with Health… more
- Army National Guard Units (Santa Fe, NM)
- …is knowledgeable of special handling techniques and procedures required for the processing of hazardous and toxic materiel such as explosives, toxic chemicals, ... flammables, gas cylinders, radioactive material, hazardous waste and medical waste. Examine clothing, textiles, requiring sensory judgment as well as subjective… more