- Humana (Santa Fe, NM)
- …our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business ... the Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support… more
- Genesis Healthcare (Albuquerque, NM)
- …long term care clinical nursing experience is required. *Experience with Medicare/ Medicaid reimbursement , MDS completion, clinical resource utilization and/or ... of high-quality care and exceptional service. As a leading provider in the long-term care industry, we believe in...RN manages the overall process and tracking of all Medicare/ Medicaid case-mix documents to ensure appropriate reimbursement … more
- Genesis Healthcare (Albuquerque, NM)
- …of long-term care clinical nursing experience is required. *Experience with Medicare/ Medicaid reimbursement , MDS completion, clinical resource utilization and/or ... of high-quality care and exceptional service. As a leading provider in the long-term care industry, we believe in...as required by federal and state regulations. *Manage all Medicare/ Medicaid case-mix documents at the nursing center to assure… more
- Genesis Healthcare (Albuquerque, NM)
- …standards of care. *Manage the overall process and tracking of all Medicare/ Medicaid case-mix documents to assure appropriate reimbursement for services provided ... through the delivery of high-quality care and exceptional service. As a leading provider in the long-term care industry, we believe in fostering a collaborative,… more
- Humana (Santa Fe, NM)
- …- 5 years of experience in negotiating managed care contracts with physician, hospital and/or other provider contracts. + Proficiency in analyzing, understanding ... part of our caring community and help us put health first** The Provider Contracting Professional 2 initiates, negotiates, and executes dental provider contracts… more
- Molina Healthcare (Las Cruces, NM)
- …and/or functional requirements related to but not limited to coverage, reimbursement , and processing functions to support systems solutions development and ... **JOB DUTIES** + Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to… more
- Molina Healthcare (NM)
- …modeling current and future contract rate proposals. * Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of ... Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard. * Generate hospital performance analytics tools on a quarterly basis; develop reports on… more
- Molina Healthcare (Santa Fe, NM)
- …modeling current and future contract rate proposals. + Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of ... Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard. + Generate hospital performance analytics tools on a quarterly basis; develop reports on… more
- Molina Healthcare (Rio Rancho, NM)
- …(UB04/1500 form). * Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS ... from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions… more
- Humana (Santa Fe, NM)
- …for services rendered is complete, compliant and accurate to support optimal reimbursement . The Nurse Auditor 2 work assignments are varied and frequently require ... in the state they reside. + Minimum of 2 consecutive years acute inpatient hospital care experience in critical, intensive care setting within the last 5 years (Not… more
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