Commercial & Healthcare Regulatory Counsel Alto IncCommercial & Healthcare Regulatory CounselNMRemote$135,000–$185,000 / yearPhysical requirements for this role include the ability to work at a computer terminal with monitor, keyboard and mouse for extended periods of time, stoop, bend, and reach for equipment and supplies, make frequent repetitive motions required to operate a computer that include the wrists, hands and fingers, and lift, carry, push, pull, and move light objects up to 20 pounds. Issue-spot and provide practical guidance on applicable laws and regulations, such as the Anti-Kickback Statute (AKS), Stark Law, False Claims Act, FDA/DEA requirements relevant to pharmacy and telehealth operations, state pharmacy/professional licensing, PBM contracting/network participation, and HIPAA/HITECH.
Lead Director, Healthcare Medicaid Risk Adjustment Analytics CVS Health CorpLead Director, Healthcare Medicaid Risk Adjustment AnalyticsNM$100,000–$231,540 / yearThe Lead Director should also demonstrate leadership in innovation and adoption of modern technologies, data platforms, machine learning, process automation, AI, and data science for optimized insights, workflows, reporting, and process controls. This senior-level role will provide strategic and operational leadership for all Medicaid risk adjustment analytics, reporting, and informatics functions to ensure complete, accurate, and compliant revenue capture.
Healthcare Controller Southwest CARE CenterHealthcare ControllerNMWorking in parallel with our veteran Accounting Manager, the Controller will lead the Financial Planning & Analysis (FP&A) function, oversee complex grant compliance, and drive the evolution of our Workday ERP system. This position supports all SCC locations in Santa Fe and Albuquerque; therefore, candidate must reside in the local market area of Albuquerque or Santa Fe, New Mexico and able to travel between the two cities as needed.
Technical Support Analyst IT Help Desk Healthcare Southwest CARE CenterTechnical Support Analyst IT Help Desk HealthcareNMCandidate Highlights: Experience: Minimum (1) year of hands-on hardware troubleshooting experience, with working knowledge of electronic medical record systems and experience working in a healthcare environment highly desired. Deliver required desktop service levels by installing, configuring, testing, maintaining, monitoring, and troubleshooting end-user workstations and related hardware and software.
Account Manager West Region - Fire & EMS - Hospital & Healthcare ESO Solutions IncAccount Manager West Region - Fire & EMS - Hospital & HealthcareSanta Fe, NMEducate clients and partners on ESOs healthcare data and quality management solutions through presentations, workflow demonstrations, and collaboration with clinical subject matter experts. Your focus will be ensuring clients continued success with ESOs platform while identifying upsell opportunities and deepening our integration within health networks, trauma centers, and hospital-based EMS programs.
RN - Home Healthcare - PRN Presbyterian Healthcare ServicesRN - Home Healthcare - PRNNMPresbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more. Demonstrates professional accountability for self-scheduling patient case load with appropriate frequency and duration, and concurrently updates schedule throughout the day as needed so that ongoing patient needs can be met.
Senior Healthcare Internal Audit Consultant Banner HealthSenior Healthcare Internal Audit ConsultantNMRemote$43.77–$72.95 / hourMust possess one of the following certifications within 12 months of hire: Professional designations such as Certified Public Accountant (CPA), Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE), or Certified Healthcare Internal Audit Professional (CHIAP). Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.
Strategic Account Executive - Healthcare UKGStrategic Account Executive - HealthcareSanta Fe, NM$90,000–$95,000 / yearThis Account Executive will be in a role of focusing on both acute and non-acute care accounts between 1-500 employees; the role requires a hunter focus on existing accounts seeking to add on Payroll, HR, Talent, Benefits, and additional HCM products, as well as expanding their labor management solution with additional products such as absence management, scheduling, and the analytics solutions. This person will be tasked with creating and maintaining key stakeholder relationships, in the accounts, and maximize opportunities to attain and exceed annual sales goals for the territory and the UKG Healthcare sales team.
Healthcare Business Development Manager Stride, Inc.Healthcare Business Development ManagerSanta Fe, New MexicoThe Enterprise Healthcare Partnerships Manager will oversee the entire business development process, from prospecting and pipeline expansion to negotiating deals and closing agreements, with the aim of securing new enterprise partnerships, increasing MedCerts' presence in various healthcare delivery models, and driving measurable revenue growth. The Enterprise Healthcare Partnerships Manager is responsible for generating new business and expanding MedCerts' partnerships across the healthcare spectrum, including health systems, hospitals, ambulatory networks, and post-acute providers.
Contact Representative (PRC) US Department of Health and Human ServicesContact Representative (PRC)NM$45,409–$72,644 / yearGS-08: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-07 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: applying and interpreting complex federal, state, Tribal, and private-sector regulations to make eligibility and funding determinations for programs such as Purchased/Referred Care, Medicare, Medicaid, Veterans Affairs healthcare, and Affordable Care Act plans; independently analyzing medical, financial, and eligibility documentation to resolve complex or controversial benefit issues; coordinating with agencies, providers, and patients to ensure fiscal accountability and continuity of care; issuing medical authorizations or denial determinations based on regulatory, clinical, and fiscal requirements; maintaining fund control records, monitoring expenditures, and applying appropriate accounting codes; identifying and resolving program or funding discrepancies; and compiling and analyzing reports related to program operations, funding, and utilization. MINIMUM QUALIFICATIONS: GS-06: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-05 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: identifying and verifying patient eligibility for Medicare, Medicaid, SSA benefits, private insurance, Tribal programs, and other assistance resources; interviewing patients to obtain required documentation; assisting individuals and families with benefit applications; reviewing records to determine the status of claims and applications; responding to inquiries regarding patient eligibility requirements, benefits, and program guidelines; and maintaining accurate patient records through data entry, discrepancy resolution, and follow-up on pending claims and missing documentation.
Contact Representative (Benefits Coordinator) US Department of Health and Human ServicesContact Representative (Benefits Coordinator)NM$45,409–$72,644 / yearGS-08: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: interpreting and applying federal, state, Tribal, and third-party program regulations to determine eligibility and ensure compliance for programs such as Purchase Referred Care, Medicare, Medicaid, Affordable Care Act, Veterans Affairs Healthcare, and other alternate resources; conducting in-depth patient interviews to assess eligibility, verify coverage, and complete applications; registering eligible patients in various assistance programs; resolving claim denials and eligibility issues through coordination with patients, healthcare providers, and outside agencies; reviewing Medicaid eligibility information and supporting billing requirements; and utilizing effective oral and written communication to explain program requirements, provide referrals, and resolve complex patient service issues. MINIMUM QUALIFICATIONS: GS-06: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-05 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: determining patient eligibility for alternate resources programs; interpreting and applying Medicare, Medicaid, VA, and other third-party payer policies and procedures; conducting patient interviews to identify available healthcare coverage and funding sources; assisting patients with enrollment and claims processes; researching and resolving eligibility, denial, and reimbursement issues; maintaining effective working relationships with patients and resource agencies; and safeguarding confidential patient information in accordance with Privacy Act and HIPAA requirements.
Revenue Cycle Auditor RN - Full time, Day, Remote Providence Health & ServicesRevenue Cycle Auditor RN - Full time, Day, RemoteNMRemoteRequsition ID: 437237 Company: Providence Jobs Job Category: Revenue Cycle Operations Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 4001 SS RC REV INTEGRITY Address: OR Portland 4400 NE Halsey St Work Location: Providence Health Plaza (HR) Bldg 1-Portland Workplace Type: On-site Pay Range: $See Posting - $See Posting The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Revenue Cycle Auditor RN - Full time, Day, Remote Providence St. Joseph HealthRevenue Cycle Auditor RN - Full time, Day, RemoteSanta Fe, NMRemoteTogether, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Vendor Manager Alto IncVendor ManagerNMRemote$108,000–$135,000 / yearPhysical requirements for this role include the ability to work at a computer terminal with monitor, keyboard and mouse for extended periods of time, stoop, bend, and reach for equipment and supplies, make frequent repetitive motions required to operate a computer that include the wrists, hands and fingers, and lift, carry, push, pull, and move light objects up to 20 pounds. You'll be managing a broad portfolio of technology and services vendors across our five entities, driving governance into an estimated $10-15M of currently unmanaged spend, and working directly with Legal, Finance, Compliance, Security, and business leadership to make sure our vendor relationships are structured, compliant, and delivering value.