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New Mexico Department of Health · 8 hours ago

Utilization Review Healthcare Program Coordinator (DOH/NMRC #11961)

Roswell, NM

Full-time

Onsite

New Grad, Entry Level

$21.96/hr - $32.94/hr

0+ years exp

New Mexico Department of Health is seeking a Utilization Review Healthcare Program Coordinator to provide direct client services for eligible patients at the New Mexico Rehabilitation Center. The role involves interfacing with insurance companies, managing documentation for patient care, and contributing to the improvement of services.

Health Care

Responsibilities

Provide direct client services for medically and financially eligible clients to attain mutually determined goals; gather, generate and maintain appropriate records and accurate completion of forms for social work intervention, expand, enhance and contribute to the improvement of services of the New Mexico Rehabilitation Facility program

This position will be responsible for directly interfacing with insurance companies (i.e. seeking authorization for patient care, providing documentation that supports services provided, clarifies questions from insurance companies Re; services and status of patient, documents all interactions with insurance companies; communicates directly with biller Re: patient payment issues

Trends all denial data and identifies improvements necessary for increased collection rates, Interfaces with biller daily, checks insurance coverage through various portals for all levels of care, analyze admission data management, spreadsheets, etc., conducts training with various treatment teams and identifies ways to improve documentation for payment purposes

Investigate patient status and D/C plans for payment purposes, assists biller in claim tracking and denial tracking, will act as back up for Medical Secretary

Qualification

Medical terminologyData entryPoliciesProceduresAttention to detailTime managementMulti-taskingCommunication skillsSelf-starter

Required

High school diploma or equivalent

Six (6) months experience with a public assistance program, medical, healthcare, educational, and/or state facility working with policies and procedures, conducting analysis/research, and/or providing or requesting information from the general public

Any combination of education from an accredited college or university in a related field and/or direct experience in this occupation totaling six (6) months may substitute for the required experience

Employment is subject to nationwide criminal background check and is conditional pending results

Must possess and maintain a valid Driver's License

Must possess and maintain a current Defensive Driving Course Certificate from the State of New Mexico or must pass and receive Defensive Driving Course Certification as a condition of continued employment

Successful completion of Health Insurance Portability and Accountability Act (HIPAA)