- CVS Health (Santa Fe, NM)
- …systems and on daily operations and programs + Responsible to support targeted quality audit projects. Report results and make recommendations eg, training ... service to our internal and external customers. **Position Summary** + Performs routine quality audits for network operations and claim testing for PPO … more
- Molina Healthcare (NM)
- …time and quality . + Audit loaded provider records for quality and financial accuracy and provide documented feedback. + Ensure that provider ... DESCRIPTION** **Job Summary** Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains… more
- Magellan Health Services (Albuquerque, NM)
- …organizational providers to meet network adequacy standards and assure quality network . + Conducts and coordinates contracting and amendment initiatives. ... lines of business. Interacts with all areas of organization to coordinate network management and network administration responsibilities. + Assesses network… more
- Cardinal Health (Santa Fe, NM)
- …patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to ... and continuous improvement. Accurately score interactions to gauge employee's quality performance based on organizational and departmental policies and requirements.… more
- Highmark Health (Santa Fe, NM)
- …retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, ... **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Performs all...in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of… more
- Cardinal Health (Santa Fe, NM)
- …patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to ... point of contact handling inbound calls, with ability to determine needs and provide one call resolution + Process enrollments via inbound fax, phone, and… more
- Humana (Santa Fe, NM)
- …with upstream business partners such as Claims, Clinical Guidance, and the Provider Network to identify opportunities and drives initiatives that will ... midst of a people, process and technology transformation that will improve quality , timeliness and the overall experience for our associates, members and providers.… more
- Amazon (Los Lunas, NM)
- …associates are trained and knowledgeable of their responsibilities under each policy * Audit the quality , delivery (including qualifications of the trainer), and ... SME of local/regional regulations and company WHS policy. * Provide guidance and oversight to ensure compliance to all...to support business safety initiatives. * Deliver on-time and quality projects to Operations. * Deep Dive safety metrics… more
- Cardinal Health (Santa Fe, NM)
- …patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to ... using the appropriate database for the inquiry + Must self- audit intake activities to ensure accuracy and efficiency for...the program + Make outbound calls to patient and/or provider to discuss any missing information as applicable +… more
- Cardinal Health (Santa Fe, NM)
- …patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to ... may receive general guidance on new assignments + May provide general guidance or technical assistance to less experienced...inquiry + Make all outbound calls to patient and/or provider to discuss any missing information and/or benefit related… more
- Cardinal Health (Santa Fe, NM)
- …experience, preferred. Diploma or degree in relevant field desirable. + 3+ years' call quality audit experience strongly preferred. + 3+ years' experience in a ... remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer...that can be improved or celebrated. + Analyze and provide weekly & monthly trend analysis to leadership. +… more
- Datavant (Santa Fe, NM)
- …presenting to leadership, clients, and your Team via Video or in person. + Solution provider and forward thinking + Detail and quality oriented as it relates to ... is powered by the largest, most diverse health data network in the US, enabling data to be secure,...with leadership on issues, opportunities, or challenges. + Lead Audit Team which receives requests from Payors + Review… more
- Nelnet (Santa Fe, NM)
- …with the industry standards for compliance and information security issues to provide our customers with world class information security & compliance services. ... with the industry standards for compliance and information security issues to provide our customers with world class information security & compliance services. The… more
- Datavant (Santa Fe, NM)
- …life experiences to realize our bold vision for healthcare. The individual will provide superior quality by performing audits pertaining to risk adjustment ... is powered by the largest, most diverse health data network in the US, enabling data to be secure,...pertaining to auditing functions as assigned. The individual will provide superior customer experience by educating internally and externally… more
- Amazon (Albuquerque, NM)
- …is seeking self-motivated Driver Trainers to join our team and help build a network of customer-centric Delivery Associates in the communities where we operate. As a ... instructing training sessions. You educate Delivery Associates on the foundational safety, quality , and productivity aspects that are an important part of the… more
- Datavant (Santa Fe, NM)
- …the right format. Our platform is powered by the largest, most diverse health data network in the US, enabling data to be secure, accessible and usable to inform ... content to re-educate team on coding error trends + Train and provide ongoing teaching/technical assistance to internal staff/external partners + Oversee the… more