- Health Care Service Corporation (Albuquerque, NM)
- …needs of a specific domain for supplier management services. Customer service, IT, health care management or data and analytics solutions of the supplier management ... analytical and collaboration skills. **Preferred Job Qualifications:** + Knowledge of HCSC claim systems + Knowledge of HCSC Payment Integrity Offerings + Knowledge… more
- Humana (Santa Fe, NM)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to ... services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work assignments are varied and frequently require… more
- Health Care Service Corporation (Albuquerque, NM)
- …**Required Job Qualifications:** + Bachelor's degree and 2 years of experience in health care services, statistical analysis, or insurance industry economics or ... in related field OR 6 years of experience in health care services, statistical analysis, or insurance ...+ Experience of Healthcare industry - mainly pharmacy related claims . + Experience with Medicare Part D and CMS… more
- Health Care Service Corporation (Albuquerque, NM)
- …This position may be responsible to manage low-risk members for health -related social needs, education, and basic member outreach screenings/inquiries. **Required ... of medical or healthcare terminology. + Knowledge of clinical systems ( claims , enrollment, documentation). + PC proficiency including Microsoft Office applications.… more
- Highmark Health (Santa Fe, NM)
- …all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the ... Epic modules. **Preferred** + 2+ years of Healthcare Revenue Cycle experience ( Claims , Patient Access, Billing) + Epic Certification in Resolute Hospital Billing… more
- Humana (Santa Fe, NM)
- **Become a part of our caring community and help us put health first** The Senior Payment Integrity Professional uses technology and data mining, detects anomalies ... in data to identify and collect overpayment of claims . Contributes to the investigations of fraud waste and...PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Humana (Santa Fe, NM)
- …us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met. ... **Use your skills to make an impact** **WORK STYLE:** Remote /Work at home **WORK HOURS:** Associates will work on...Health , and minor procedures + Experience with the Claims Life Cycle + Experience with coding/auditing Professional Inpatient… more
- CenterWell (Santa Fe, NM)
- **Become a part of our caring community and help us put health first** The Clinical Pharmacy Technician assists the interdisciplinary CIT team with ... + Assist clinical pharmacists in troubleshooting prescription third party claim rejections by accessing and understanding formulary restrictions, plan limitations,… more
- Humana (Santa Fe, NM)
- …for the provider reimbursement programs for an organization that provides health insurance . The Senior Provider Reimbursement Professional works assignments ... **Become a part of our caring community and help us put health first** The Senior Provider Reimbursement Professional - Certified Medical Coder performs research,… more
- Humana (Santa Fe, NM)
- **Become a part of our caring community and help us put health first** The Pharmacy Contracting Professional 2 ensures contract compliance and performs analysis ... regarding pharmacy claims . Understands department, segment, and organizational strategy and operating...on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training… more