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Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. Must complete Presbyterian quality training or Lean Six Sigma Green Belt or equivalent process improvement certification/experience within three years of employment.
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Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. The Polysomnography Tech is responsiible for the performance and analysis of Polysomnograms ( Sleep Studies.
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Experience in Medicare/Medicare Advantage and value-based care. - Analyze Medicare Advantage and Accountable Care Organization data. - Project Medicare Risk scores and estimate premiums.
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The physician works closely with pharmacists on medication management including reduction and reconciliation as necessary, they complete all federally mandated visits including initial H&Ps, Medicare required visits, and acute and follow up visits as medically necessary in collaboration with the nurse practitioner (NP) or physician assistant (PA.
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Responsible for the strategic development and administration of Molina Healthcare of New Mexico Native American programs and tribal partnerships in support of all lines of business, including but not limited to the Indian Managed Care Entity (IMCE), Medicaid, Medicare, and Marketplace.
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The AVP will play a key leadership role on the HQRI team, partnering directly with the HQRI leadership team, leaders across the enterprise, including Market leadership, and external companies to create Medicare Risk Adjustment strategies to support Humana's industry leading position.
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This key leadership role is integral in helping to support hospital operations at Presbyterian Hospital (562 licensed beds) and Rust Medical Center (210 licensed beds). You'll lead a team of discharge planning and utilization management professionals - experts in helping to transition our community back to post-acute care and home.
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Minimum 3 years of Hospital chargemaster experience, including the use of CDM Maintenance software and experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology.
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Ensure all provider enrollment data is properly controlled and tracked to ensure applications are approved or denied within standards of timeliness established by department and Centers for Medicare and Medicaid Services (CMS.
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The purpose of this position is to complete eligibility and benefit verification to ensure the timely and accurate submission of claims (i.e. insurance companies, Medicare and Medicaid, employers, individuals, etc.
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We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad.
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ELIGIBILITY - Determine and process eligibility for financial assistance (Including Medicaid, SCI, UNM Care, Commercial, Medicare, PHS/Indian Health Service, Salud, Self Pay) Do the Census reports for PBX. Work Medicare secondary payor report as assigned.
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Labor & Delivery staffed by PMG physician, Back up OB Hospitalist, CNM, independent group physician 24/7. Add in Albuquerque s International Balloon Fiesta, Los Alamos nuclear scientists, Roswell s visitors from outer space, and Santa Fe s artists, and you get an eclectic mix of people, places, and experiences that make this state great.
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The Cash Posting Representative is responsible for properly and accurately posting payments received from Medicare, Medicaid, commercial Insurance Companies and Patients, recording and reconciling these postings monthly against a bank statement or similar document.
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The purpose of a Primary Care Physician at Oak Street Health is to provide equitable and effective value-based healthcare to local medicare patient populations at our innovative network of neighborhood primary care centers.
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medicare job in Albuquerque, NM
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