- Molina Healthcare (Albuquerque, NM)
- …**Job Summary** Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines, ... and provider compliance. Interacts with health plans and vendors regarding recovery outstanding overpayments. **Job Duties** + Prepares written provider overpayment… more
- Western Digital (Santa Fe, NM)
- …**Job Description** **Position Summary** We are looking for a **Retail Compliance Specialist ** to join the Western Digital Fulfillment Operations Team to be ... chargebacks, late deliveries, labeling errors, incorrect shipments. Review and validate claims received from retail partners to determine legitimacy and compliance… more
- Molina Healthcare (Roswell, NM)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... and State regulatory requirements are met for Pre-pay Edits, Overpayment Recovery which improves encounter submissions, reduces General and Administrative expenses… more
- Molina Healthcare (Santa Fe, NM)
- …review to facilitate a referral to law enforcement or for payment recovery . **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical ... records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines,...+ AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred + Certified Fraud Examiner and/or AHFI professional… more
- General Dynamics Information Technology (Las Cruces, NM)
- …customer service? Is helping callers resolve their questions regarding insurance claims and how their Medicare benefits coordinate with other insurance coverage ... questions from customers regarding Coordination of Benefits, Medicare Secondary Payer claims , and billing questions within a fast-paced call center environment. This… more