Job Listings

Now hiring a Provider Network Management Relations Service Associate Primarily responsible for supporting the Network Relations Service Executive. With limited supervision responds to and resolves complex issues related to daily operations. The Network Relations Service Associate assists with data collection and distribution of clinical quality measures to the provider network in accordance with PHP s quality and incentive programs. Ensures providers receive exceptional service when responding to inquiries. The position assures an exceptional provider experience in support of organizational service goals including provider satisfaction and retention through ongoing network relationship development and management....

Now hiring a Health Services Assistant Responsible for supporting Health Services Coordination functions including, but not limited to, medical records coordination, technical retrospective claims review, referral/auth. entry, research which may include but not limited to claims, eligibility, benefits, provider contracts, coordination of benefits, provider education, data entry report generation, act as liaison to and/or assists PHS clinical leaders How you belong matters here. We value our employees' differences and find strength in the diversity of our team...

Now hiring a Utilization Management Nurse Specialist   Albuquerque Metro Residents Only. The UM Nurse Specialist conducts clinical reviews to ensure that services provided to members meet clinical criteria and are delivered in appropriate settings. Using clinical expertise, coordinates, documents, and communicates all aspects of utilization and benefit management, handling both prospective (pre-service and concurrent) and retrospective care reviews. They assist providers and members in coordinating care with in-plan providers and preferred out-of-plan providers. Responsibilities include validating...

  Now Hiring: Clinical Documentation Specialist!   Presbyterian is seeking for a Clinical Documentation Specialist.  This position requires a proactive individual with the confidence to address documentation concerns while maintaining positive relationships with medical staff. If you’re ready to make a meaningful impact in clinical documentation, we’d love to hear from you! We are seeking a detail-oriented...

Now hiring a Technical Assistant/Courier – Hospital at Home.  Albuquerque Residents Only   Presbyterian is seeking a dedicated Technical Assistant/Courier to join our innovative Hospital at Home team. As a Technical Assistant/Courier, you will play a pivotal role in enhancing patient care through your technical expertise and support. In this dynamic position, you will not only provide essential courier services by transporting lab specimens, medications, and medical supplies to patients' homes but also serve as a...

Now hiring a PCSC Training Specialist Responsible for assessing, developing, delivering, documenting, and evaluating learning and training programs for specific jobs or processes for Presbyterian Customer Service Center. Responsible for providing customer service for members in the Salud, Medicare, IBAC, and Commercial plans; Provider Care; PMG patient scheduling; Financial Services; and Broker Services How you belong matters here. We value our employees' differences and find strength in the diversity of our team and community. At...

Now hiring-Medicare Financial Advocate Specialist   Responsible for providing customer service for members to help facilitate financial security by assisting our members with eligibility to qualify for full or partial dual enrollment. Provide proactive member outreach and education about program benets, advocating on behalf of interested and eligible members. From submitting forms to monitoring approvals to appealing denials, the member is guided throughout the process from start to finish.   How you belong matters here.

Now hiring a Claims Configuration Medical Policy & Coding Specialist A liaison role in the organization between different departments of the Presbyterian Health Plan (PHP) outpatient services. Manage collaboration among multidisciplinary teams to resolve from beginning to end - which may entail preparation, execution, feedback and resolution of claims, coding and system configuration. Responsible for the research, analysis, planning, implementation, evaluation, and development of Payment Integrity configuration by providing guidance and oversight for translating medical policies into rules that may promulgate from either external purchased...

Now hiring a Medical Coder & Policy Research Specialist   Manage collaboration among multidisciplinary teams to resolve from beginning to end -  which may entail preparation, execution, feedback and resolution of claims, correct coding  and policy review. A liaison role in the organization between different departments of the Presbyterian Health Plan (PHP) outpatient services. Manage collaboration among multidisciplinary teams to resolve from beginning to end - which may entail preparation, execution, feedback and resolution of claims, coding and system configuration. Responsible for...

Now hiring a Bed Management Coordinator Presbyterian is seeking a skilled Bed Management Coordinator to be responsible for patient throughput and flow coordination in collaboration with the nursing bed coordinator and/or hospital supervisor, and entry of all admission, discharge and transfer (ADT) activity in EPIC at Presbyterian and Kaseman Hospitals. The bed controller is also responsible for interacting with medical staff within the system and those referring patients to Presbyterian, ensuring patients are admitting at the appropriate admission status, ensuring accommodation codes are accurate in Medipac, and escalating issues negatively...

Now hiring a Pro Fee Surgery Coder Has the knowledge and ability and will be required to code all of the following: inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services for PMG specialty providers or demonstrate coding expertise in a specific specialty deemed a critical business need by PHS Coding Leadership using the ICD-9/10 CM and CPT-4 classification system. Ensures adherence to Hospital and Departmental Policies and Procedures How you belong matters here. We value our employees' differences and find strength in the...

Now hiring a Network Contract Manager  The Provider Network Specialist is responsible for identifying network expansion opportunities and facilitating key recruitment related activities. The Provider Network Specialist drafts, reviews, negotiates and finalizes standard provider agreements, which includes but is not limited to single financial agreements based on sound analytical principles and approaches. The Provider Network Specialist provides implementation and ongoing support to Value Based Reimbursement and Value Based Program providers. The NCM I work assignments involve a low to moderately complex of variable factors. Work with minimal...

Are you a strategic thinker with a passion for financial systems and process improvement? Presbyterian Healthplan is seeking a Systems Finance Manager to lead the development of financial models, streamline reporting, and optimize data integrations across our systems. In this role, you will play a critical part in enhancing financial processes, ensuring seamless collaboration between Finance, Information Technology, Analytics, and other key departments. Your expertise in general ledger systems, planning and reporting applications, data marts, accounting principles, and health insurance will be essential in driving efficiency and accuracy across our financial operations.

Now hiring a IP Facility Coder III CCS   Has the knowledge and ability and will be required to code all of the following: inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services for PMG specialty providers or demonstrate coding expertise in a specific specialty deemed a critical business need by PHS Coding Leadership using the ICD-9/10 CM and CPT-4 classification system. Ensures adherence to Hospital and Departmental Policies and Procedures How you belong matters here. We value our employees' differences...

Now hiring a DRG/PCS IP Facility Coder   Has the knowledge and ability and will be required to code all of the following: inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services for PMG specialty providers or demonstrate coding expertise in a specific specialty deemed a critical business need by PHS Coding Leadership using the ICD-9/10 CM and CPT-4 classification system. Ensures adherence to Hospital and Departmental Policies and Procedures How you belong matters here.

Now hiring a Sourcing & Contracting Analyst   Provides support to Sourcing and Contract Managers with analytics to support contracting activities and the Value Analysis process. Maximizes GPO and Industry technologies to review supply spend, benchmarks, contract commitments and terms. Utilizes analytic tools (Power BI, Excel, etc.) to pull annual spend and usage reports. Reviews product quotes and benchmarks using national benchmark tools and makes recommendations for price point to S&C Manager. Leverages current spend/usage report and quote to...

Now hiring a Home health & Hospice Coder Has the knowledge and ability and will be required to code all of the following: inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services for PMG specialty providers or demonstrate coding expertise in a specific specialty deemed a critical business need by PHS Coding Leadership using the ICD-9/10 CM and CPT-4 classification system. Ensures adherence to Hospital and Departmental Policies and Procedures How you belong matters here. We value our employees' differences and find...

Now hiring a Value-Based Programs Engagement Manager Anticipates, develops and implements health management programs and initiatives. Achieves clinical and fiscal improvements for their identified programs. Meets regulatory requirements. How you belong matters here. We value our employees' differences and find strength in the diversity of our team and community. At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical...

Now hiring a Employee Assistance Program Counselor The EAP counselor provides clinical services, develops, and presents training programs, and delivers program support functions directly to eligible employee assistance program clients and program participants. Works in concert with EAP clinical and administrative staff on ways to improve efficiency and delivery of services. Provide EAP services at client on-site locations. A member of the EAP Clinical team. This hybrid (remote and office work) position delivers direct services to individuals and groups using clinical assessment, brief solution focused counseling, coaching, consulting, mediation, crisis response to...

Now hiring a Sales/Marketing Coordinator Responsible for supporting and coordinating administrative functions of the Sales and Marketing Department activities in conjunction with the sales of fully insured and self-funded commercial accounts. Serves as secondary source of contact for Brokers, prospects and employer groups. Responsible for timely submission of reports, proposal requests and new groups to meet department and corporate goals. Responsible for developing relationships with Broker administrative support to ensure maximum information obtained for risk assessment and Broker loyalty