Manager - Arbitration Operations MaximusManager - Arbitration OperationsAlbuquerque, NMFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - Frequent interaction with subordinate employees, customers, and/or functional peer group managers, normally involving matters between functional areas, other company divisions or units, or customers and the company.
NewPrior Authorization Specialist Southwest Womens Oncology/OptimumPrior Authorization SpecialistAlbuquerque, NMFull timeYou will work closely with:Providers and clinical staff on order review, documentation completeness, and peer-to-peer coordinationNurses and infusion schedulers to ensure authorizations are secured prior to every treatment appointmentSurgery schedulers on surgical authorization timelines and operative plan documentationPharmacy on specialty medication authorization and oral oncology coordinationBilling and coding staff to ensure authorized services align with CPT, HCPCS, and ICD-10 requirementsYour accuracy, urgency, and follow-through directly determine whether patients get to their care on time. The OpportunityThe Prior Authorization Specialist is responsible for obtaining timely insurance authorizations for clinic-based services-including infusion therapies such as chemotherapy, immunotherapy, and biologics; surgical procedures; and oral and specialty medications-ensuring patients receive medically necessary care without delays.
Patient Accounting Denials Specialist I Presbyterian Healthcare ServicesPatient Accounting Denials Specialist INMExcellent organizational, problem-solving, verbal, and written communication skills, along with, attention to detail and the ability to interact effectively with other functional areas and management teams are required. All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Patient Experience Specialist ALLEVIO CARE, LLCPatient Experience SpecialistSANTA FE, NMCollect copays and other fees and perform proper money handling tasks (Total daily deposits, make copies of receipts, fill out daily deposit log). Proven initiative and a proactive mindset— you're someone who takes ownership, problem solves, works with a sense of urgency and drives projects forward.
Patient Access Specialist Ensemble Health PartnersPatient Access SpecialistAlbuquerque, NM$17–$18.15 / hourJob Responsibilities: Patient Access staff are responsible for assigning accurate MRNs, completing medical necessity / compliance checks, providing proper patient instructions, collecting insurance information, receiving, and processing physician orders, and utilizing an overlay tool while providing excellent customer service as measured by Press Ganey. Responsible for accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare and distribution of the ABN as appropriate.
NewPatient Accounting Specialist Eye Associates of New MexicoPatient Accounting SpecialistAlbuquerque, NMJoin EANM as a fulltime, Patient Accounting Specialist , responsible for supporting our revenue cycle and patient billing operations while also assisting with contact lens and other order processing. If you have a passion for solving billing challenges, delivering great service, and contributing to quality patient care behind the scenes, this role is for you!
Pharmacy Benefits Verification Specialist Onco360Pharmacy Benefits Verification SpecialistAlbuquerque, New MexicoSkills/Knowledge: Required: Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills. Pharmacy Benefit Verification Summary The Benefit Verification Specialist will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, assign coordination of benefits, run test claims to obtain a valid insurance response on patient medications, investigate/identify authorization requirements needed to obtain medication coverage, and enroll eligible patients in copay card assistance programs.
Sr. Patient Access Specialist Ensemble Health PartnersSr. Patient Access SpecialistAlbuquerque, New MexicoReviews eligibility responses in insurance verification system and appropriately selects the applicable insurance plan code, enters benefit data into system to support POS (Point of Service Collections) and billing processes to assist with a clean claim rate including pre-registration of patient accounts prior to the patient visit which may include inbound and outbound calls to obtain demographic information, insurance information, and all other patient information. Essential Job Functions: Patient Access staff are responsible for assigning accurate MRNs, completing medical necessity or compliance checks, providing proper patient instructions, collecting insurance information, receiving, and processing physician orders while utilizing an overlay tool and providing excellent customer service as measured by Press Ganey.
Pharmacy Claims Adjudication Specialist Onco360Pharmacy Claims Adjudication SpecialistAlbuquerque, New MexicoSkills/Knowledge Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360.
Neurology Account Specialist - (El Paso, TX) (US Field Based) Eisai USNeurology Account Specialist - (El Paso, TX) (US Field Based)Albuquerque, NMExperience working with U.S. healthcare industry (including delivery of care, market access and reimbursement landscape, and key stakeholders that influence decision-making within local markets and healthcare systems). Skills:Clinical Acumen (AD), Critical Thinking & Agility, Focus On Customers & Partners, Sales Ops & Data Analytics, Sells Effectively & Makes Impact, Territory/Account Management.
Neurology Account Specialist - (El Paso, TX) (US Field Based) Eisai IncNeurology Account Specialist - (El Paso, TX) (US Field Based)Albuquerque, NMExperience working with U.S. healthcare industry (including delivery of care, market access and reimbursement landscape, and key stakeholders that influence decision-making within local markets and healthcare systems). Skills:Clinical Acumen (AD), Critical Thinking & Agility, Focus On Customers & Partners, Sales Ops & Data Analytics, Sells Effectively & Makes Impact, Territory/Account Management.
Account Operations Tech 1 UNM Medical Group, Inc.Account Operations Tech 1Albuquerque, NMPerforms a variety of routine day-to-day operations related to the administration of billing accounts for a defined University medical service or billing agent. We ASPIRE to incorporate the following values into all aspects of our culture and work: we always demonstrate an Attitude of Service with Positivity , Integrity and Respect as we strive for Excellence .
Claims Specialist- Journal Center, (784) TriCore Reference LaboratoriesClaims Specialist- Journal Center, (784)Albuquerque, NMResponsibilities include routine follow-up on accounts, working the Rejection Report for contracted insurances, analyzing aged trial balance report for assigned charge to's, working the Antrim, Rhodes reports and miscellaneous accounts receivable reports. ESSENTIAL FUNCTIONS: Collects outstanding accounts receivables on patient accounts from patient, commercial, non-government, contracted insurances or government payors via phone call to the patient or insurance company or by means of written appeal or reconsideration.
Claims Specialist-Journal Center, (783) TriCore Reference LaboratoriesClaims Specialist-Journal Center, (783)Albuquerque, NMResponsibilities include routine follow-up on accounts, working the Rejection Report for contracted insurances, analyzing aged trial balance report for assigned charge to's, working the Antrim, Rhodes reports and miscellaneous accounts receivable reports. ESSENTIAL FUNCTIONS: Collects outstanding accounts receivables on patient accounts from patient, commercial, non-government, contracted insurances or government payors via phone call to the patient or insurance company or by means of written appeal or reconsideration.
Patient Access Account Specialist Presbyterian Healthcare ServicesPatient Access Account SpecialistNMAll benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. Manage the accurate collection of patient data which includes but is not limited to; Obtain/confirm and enter demographic and other financial and clinical information necessary for final clearance of scheduled accounts.
Patient Access Account Specialist I-ABQ Presbyterian Healthcare ServicesPatient Access Account Specialist I-ABQAlbuquerque, NMAll benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. Manage the accurate collection of patient data which includes but is not limited to; Obtain/confirm and enter demographic and other financial and clinical information necessary for final clearance of scheduled accounts.
Patient Access Account Specialist Presbyterian System ServicesPatient Access Account SpecialistAlbuquerque, New MexicoAll benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. Manage the accurate collection of patient data which includes but is not limited to; Obtain/confirm and enter demographic and other financial and clinical information necessary for final clearance of scheduled accounts.
NewClinical Research Director Southwest Womens Oncology/OptimumClinical Research DirectorAlbuquerque, NMFull timeYou will work at the intersection of scientific rigor, operational excellence, and patient impact, partnering with:Gynecologic oncology physicians serving as Principal InvestigatorsPharmaceutical sponsors, CROs, and cooperative group partnersClinical Research Coordinators, data specialists, and research support staffExecutive leadership and the broader Optimum platformRegulatory bodies including FDA, NIH, and IRBYou will have the authority, the resources, and the leadership support to build a program that changes what's possible for patients in New Mexico and beyond. What You'll OwnStrategy & Program LeadershipBuild, scale, and manage the clinical research vertical within SWWO, developing long-term strategy, infrastructure, and resourcing plans.
Account Operations Tech 1 UNM Medical Group IncAccount Operations Tech 1Albuquerque, NMSummary: Performs a variety of routine day-to-day operations related to the administration of billing accounts for a defined University medical service or billing agent. We ASPIRE to incorporate the following values into all aspects of our culture and work: we always demonstrate an Attitude of Service with Positivity, Integrity and Respect as we strive for Excellence.
Patient Access Account Specialist I Presbyterian Healthcare ServicesPatient Access Account Specialist IAlbuquerque, NMEnsures accounts are financially cleared prior to date of service to alleviate patient concerns over hospital financial matters Encounter Components: Ensures accounts are financially cleared prior to date of service to alleviate patient concerns over hospital financial matters Encounter Components: • Performs the patient registration process. • External and Internal Non-Patient Access Candidates: Pass Patient Academy with passing score of 85% or higher External and Internal Non-Patient Access Candidates: Pass Patient Academy with passing score of 85% or higher • Previous completion and passing of Patient Access Advocate II and III Advancement test.