- APTIM (Santa Fe, NM)
- **Summary:** The Senior - Level Claims Reviewer is responsible for independently reviewing, analyzing, and processing complex claims related to ... on claims interpretation, policy compliance, and documentation quality. The Senior Reviewer also supports mentoring of mid- level staff, provides guidance… more
- Fujifilm (Santa Fe, NM)
- **Position Overview** We are hiring a Senior Counsel to be an integral part of the legal team providing support to the Medical Device businesses of FUJIFILM ... Inc., wholly-owned subsidiaries of FUJIFILM Holdings America Corporation (HLUS). The Senior Counsel, reporting to the Division General Counsel, Medical Devices, will… more
- Walgreens (Santa Fe, NM)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …managing agency partners ushering all necessary resources through the Promotional Review Committee process, from draft to final approval. **Qualifications:** + ... in the pharmaceutical / healthcare space and working with review committees (med/legal/regulatory) is required. - Managing agencies for...description is intended to describe the general nature and level of the work being performed by the people… more
- Walgreens (Santa Fe, NM)
- …the pharmacist, including those to physicians. Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Molina Healthcare (Santa Fe, NM)
- …skills in data analysis. Performs research and deep-dive analysis of complex healthcare claims data, CMS return files, and financial cost, revenue, and vendor data. ... multiple data sources, crosswalks, and built-in validation checks. + Use peer-to-peer review process and end-user consultation to reduce errors and rework. + Assist… more
- Molina Healthcare (Santa Fe, NM)
- …of the organization and outsourced vendor work. The Sr. Analyst providers peer level support to Analysts in the department through training and guidance on audits ... any identified finding; Supports management with presenting results and recommendations to Senior Leadership and department staff. * Recommends new or updated job… more
- Cardinal Health (Santa Fe, NM)
- …enhance the overall healthcare experience. We are seeking a highly motivated and experienced Senior Data Scientist to join our team as a thought leader and architect ... knowledge of healthcare data, including clinical data, patient demographics, and claims data. Understanding of HIPAA and other relevant regulations, preferred. +… more
- Molina Healthcare (Santa Fe, NM)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing errors and… more
- Prime Therapeutics (Santa Fe, NM)
- …to elicit and document highly complex business needs for modifications to Claims system applications, and define functional, high- level , and detailed system ... team, broader project team and various levels of management. With consistent Senior Leadership visibility, the IT BSA Sr is also responsible for partnering… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …to improve evidence planning and generation. This position reports to the Senior Director, Global Integrated Evidence Strategy and can be based in Princeton, ... study concepts and study protocols in governance meeting and review processes. + Prepare, review and present...with global and local colleagues. + Ability to gain senior leadership alignment on integrated evidence generation initiatives and… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …that drives informed decision-making at a national, regional, and territory level . **Key responsibilities:** + **Define & Measure Field Impact:** + Establish ... , fostering strong alignment with broader commercial objectives. + **Lead Business Review Framework & Execution** + Own the **business review process… more
- Cardinal Health (Santa Fe, NM)
- …Collections is responsible for the timely follow-up and resolution of insurance claims . This role ensures accurate and efficient collection of outstanding balances ... accounts receivable and increase cash flow for the organization **_Responsibilities_** + Review aging reports and work insurance accounts to ensure timely resolution… more
- Kiewit (Santa Fe, NM)
- **Requisition ID:** 177456 **Job Level :** Senior Level **Home District/Group:** Kiewit Nuclear Solutions **Department:** Business Development & Proposals ... that the requirements of the contracts are implemented and maintained. Review contract performance by monitoring compliance documents, schedules, and deliverables. *… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …and other integrated data generation initiatives. This position reports to the Senior Director, Global Integrated Evidence & Innovation Operations and can be based ... and success of projects for the GVE department. Regularly review these metrics to identify areas for improvement. +...description is intended to describe the general nature and level of the work being performed by the people… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …to support product development and regulatory submissions. + Author and review INDs, NDAs, and other regulatory submissions, ensuring accuracy, completeness, and ... related updates, strategies, and initiatives to key stakeholders and senior management. + Develop and manage comprehensive budgets for...description is intended to describe the general nature and level of the work being performed by the people… more
- Molina Healthcare (Santa Fe, NM)
- **JOB DESCRIPTION** **Job Description:** We are looking for a Senior Engineer to deliver analytics and reporting solutions that help track, measure, and optimize ... automated claims processing solutions. The role will leverage tools like...and translate requirements into technical solutions. + Lead design review sessions with cross-functional teams to validate requirements and… more
- Cardinal Health (Santa Fe, NM)
- …for process improvements and efficiencies + Work under the general supervision of senior attorneys and exercise sound judgment as to matters that require attention ... of Legal and Compliance Departments' senior leadership + Promote and ensure compliance with the...including, Antitrust; healthcare laws and regulations, (eg, Anti-Kickback, False Claims Act, and HIPAA); and Marketing and Advertising +… more
- Cardinal Health (Santa Fe, NM)
- …billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, and staff; physician and coder education; and ... and suppliers at various management levels; may interact with senior management + Interactions normally involve resolution of issues...revenue cycle team in identifying the time period of review and conducts a focused audit to identify any… more
- Walgreens (Santa Fe, NM)
- …Certification Board (PTCB) Certified Pharmacy Technician and helping you maintain the high level of skill required in the pharmacy care industry. Arming you with a ... pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient… more