- 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
- Humana (Santa Fe, NM)
- …part of our caring community and help us put health first** The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst will be an integral part of the ... of the team as it expands to accommodate the increased responsibilities. The Provider Hospital Reimbursement Analyst r will be primarily responsible… more
- Humana (Santa Fe, NM)
- … Contracting Professional helps ensure network adequacy, competitive reimbursement structures, and compliance with regulatory requirements. Through effective ... part of our caring community and help us put health first** The Senior Provider Contracting Professional serves as a primary point of contact for Humana's … more
- Molina Healthcare (Santa Fe, NM)
- …experience in Managed Care + 5 or more years hospital reimbursement methodologies + Background in provider contracts, pricing configuration, claim ... The Lead Analyst, Reimbursement is responsible for administering complex provider reimbursement methodologies timely and accurately. Supports existing lines… 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 (Santa Fe, NM)
- …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, ... in NM. Within a defined geographic area, the Clinical Reimbursement Lead models the MDS process and capability standards...support for the MDS Coordinators to meet those goals. * Provide guidance, oversight, and direction for compliance of auditing… 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
- Molina Healthcare (Santa Fe, 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 (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 (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 (Santa Fe, 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