What Jobs are available for Administration in Albuquerque?
Showing 7 Administration jobs in Albuquerque
Lead Generalist, Medicare Administration
Posted 6 days ago
Job Viewed
Job Description
**Job Summary**
Responsible for the management of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and services. Also responsible for operational compliance and adherence to federal regulations. Works collaboratively with business and operational units to ensure the Medicare and Dual Eligible operations are supported by effective, accurate and efficient business processes; benefits are accurately defined, communicated, and configured; all member communications are compliant and data exchanges and reports are accurate, timely and meet federal requirements.
**KNOWLEDGE/SKILLS/ABILITIES**
+ The lead demonstrates superior SME on health plan operations and Medicare and MMP program requirements, and is looked to within the department as a leader
+ Assist functional business owners identify and implement operational process improvements
+ Support Medicare-Medicaid plans on Medicare and MMP member retention, performance optimization, MMP reporting, and new member acquisition objectives
+ Support department leaders on wide-ranging assignments involving sales, compliance, analytics, strategy, and policy
+ Develop Medicare Advantage analytic reports.
**JOB QUALIFICATIONS**
**Required Education**
BA/BS degree or minimum equivalent employment experience of 7+ years in Health Care or related field required
**Required Experience**
7+ years of experience in the managed healthcare industry in a health plan or related field with MMP - Medicare-Medicaid plans. Must have strong, quantitative, analytical skills and ability.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $141,371 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Is this job a match or a miss?
Senior Specialist, Provider Network Administration
Posted 7 days ago
Job Viewed
Job Description
**Job Summary**
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all enrollment and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts. This role is a multi facet internal stakeholder facing position.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Bridge communication and collaboration between IT, PMO, provider network teams and business end users to align objectives and drive coordination of project delivery activities
+ Serve as a business user partner in IT development, providing requirements, input on solution/UI design, and leading user acceptance testing.
+ Lead efforts in identifying and analyzing workflow inefficiencies, recommend process improvements, and collaborate with cross-functional teams to design and implement optimized solutions that enhance operational performance and productivity.
+ Deliver customer-focused support and training to ensure smooth project delivery, successful adoption and effective utilization of implemented solutions
+ Generates and prepares provider-related data and reports in support of Network Management and Operations areas of responsibility (e.g., Provider Services/Provider Inquiry Research & Resolution, Provider Contracting/Provider Relationship Management).
+ Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database, compliance with regulatory/accreditation requirements, and Network Management business operations. Report examples may include: GeoAccess Availability Reports, Provider Online Directory (including ongoing execution, QA and maintenance of supporting tables), Medicare Provider Directory preparation, and FQHC/RHC reports.
+ Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, Network Access Fee, etc.).; and mailing label extract generation.
+ Develops and maintains documentation and guidelines for all assigned areas of responsibility.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
+ 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration.
+ 3+ years' experience in Medical Terminology, CPT, ICD-9 codes, etc.
+ Access and Excel - intermediate skill level (or higher)
**Preferred Education**
Bachelor's Degree
**Preferred Experience**
+ 5+ years managed care experience
+ QNXT; SQL experience
+ Crystal Reports for data extraction
+ 3+ years' experience in Salesforce User Interface is required.
+ Experience in User Acceptance Testing is required (UAT).
Pay Range: $77,969 - $106,214 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Is this job a match or a miss?
Specialist, Provider Network Administration (EST business hours)
Posted 9 days ago
Job Viewed
Job Description
**This role will have standard EST business hours.**
**Job Summary**
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Oversees receipt of and coordinates data from the provider network for entry into the plan's provider management system.
+ Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided.
+ Audits loaded provider records for quality and financial accuracy and provides documented feedback.
+ Assists in configuration issues with Corporate team members.
+ Assists in training current staff and new hires as necessary.
+ Conducts or participates in special projects as requested.
**JOB QUALIFICATIONS**
**Required Education**
Associate degree in Business or equivalent combination of education and experience
**Required Experience**
+ Min. 3 years managed care experience
+ Experience in one or more of the following: Claims, Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.
+ Claims processing background including coordination of benefits, subrogation, and/or eligibility criteria.
**Preferred Education**
Bachelor's Degree
**Preferred Experience**
+ 3+ years Provider Claims and/or Provider Network Administration experience
+ Experience in Medical Terminology, CPT, ICD-9 codes, etc.
+ Access and Excel - intermediate skill level (or higher)
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $21.16 - $42.2 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Is this job a match or a miss?
Lead Generalist, Medicare Administration
Posted 6 days ago
Job Viewed
Job Description
**Job Summary**
Responsible for the management of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and services. Also responsible for operational compliance and adherence to federal regulations. Works collaboratively with business and operational units to ensure the Medicare and Dual Eligible operations are supported by effective, accurate and efficient business processes; benefits are accurately defined, communicated, and configured; all member communications are compliant and data exchanges and reports are accurate, timely and meet federal requirements.
**KNOWLEDGE/SKILLS/ABILITIES**
+ The lead demonstrates superior SME on health plan operations and Medicare and MMP program requirements, and is looked to within the department as a leader
+ Assist functional business owners identify and implement operational process improvements
+ Support Medicare-Medicaid plans on Medicare and MMP member retention, performance optimization, MMP reporting, and new member acquisition objectives
+ Support department leaders on wide-ranging assignments involving sales, compliance, analytics, strategy, and policy
+ Develop Medicare Advantage analytic reports.
**JOB QUALIFICATIONS**
**Required Education**
BA/BS degree or minimum equivalent employment experience of 7+ years in Health Care or related field required
**Required Experience**
7+ years of experience in the managed healthcare industry in a health plan or related field with MMP - Medicare-Medicaid plans. Must have strong, quantitative, analytical skills and ability.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $141,371 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Is this job a match or a miss?
Senior Specialist, Provider Network Administration
Posted 7 days ago
Job Viewed
Job Description
**Job Summary**
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all enrollment and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts. This role is a multi facet internal stakeholder facing position.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Bridge communication and collaboration between IT, PMO, provider network teams and business end users to align objectives and drive coordination of project delivery activities
+ Serve as a business user partner in IT development, providing requirements, input on solution/UI design, and leading user acceptance testing.
+ Lead efforts in identifying and analyzing workflow inefficiencies, recommend process improvements, and collaborate with cross-functional teams to design and implement optimized solutions that enhance operational performance and productivity.
+ Deliver customer-focused support and training to ensure smooth project delivery, successful adoption and effective utilization of implemented solutions
+ Generates and prepares provider-related data and reports in support of Network Management and Operations areas of responsibility (e.g., Provider Services/Provider Inquiry Research & Resolution, Provider Contracting/Provider Relationship Management).
+ Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database, compliance with regulatory/accreditation requirements, and Network Management business operations. Report examples may include: GeoAccess Availability Reports, Provider Online Directory (including ongoing execution, QA and maintenance of supporting tables), Medicare Provider Directory preparation, and FQHC/RHC reports.
+ Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, Network Access Fee, etc.).; and mailing label extract generation.
+ Develops and maintains documentation and guidelines for all assigned areas of responsibility.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
+ 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration.
+ 3+ years' experience in Medical Terminology, CPT, ICD-9 codes, etc.
+ Access and Excel - intermediate skill level (or higher)
**Preferred Education**
Bachelor's Degree
**Preferred Experience**
+ 5+ years managed care experience
+ QNXT; SQL experience
+ Crystal Reports for data extraction
+ 3+ years' experience in Salesforce User Interface is required.
+ Experience in User Acceptance Testing is required (UAT).
Pay Range: $77,969 - $106,214 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Is this job a match or a miss?
Specialist, Provider Network Administration (EST business hours)
Posted 9 days ago
Job Viewed
Job Description
**This role will have standard EST business hours.**
**Job Summary**
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Oversees receipt of and coordinates data from the provider network for entry into the plan's provider management system.
+ Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided.
+ Audits loaded provider records for quality and financial accuracy and provides documented feedback.
+ Assists in configuration issues with Corporate team members.
+ Assists in training current staff and new hires as necessary.
+ Conducts or participates in special projects as requested.
**JOB QUALIFICATIONS**
**Required Education**
Associate degree in Business or equivalent combination of education and experience
**Required Experience**
+ Min. 3 years managed care experience
+ Experience in one or more of the following: Claims, Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.
+ Claims processing background including coordination of benefits, subrogation, and/or eligibility criteria.
**Preferred Education**
Bachelor's Degree
**Preferred Experience**
+ 3+ years Provider Claims and/or Provider Network Administration experience
+ Experience in Medical Terminology, CPT, ICD-9 codes, etc.
+ Access and Excel - intermediate skill level (or higher)
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $21.16 - $42.2 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Is this job a match or a miss?
Remote Work From Home Data Entry Clerk - Part Time Panelists Needed
Posted 3 days ago
Job Viewed
Job Description
Remote Work From Home Data Entry Clerk - Part Time Market Research Panelists
Our company is seeking individuals to participate in National & Local Paid Focus Groups, Clinical Trials, and Market Research assignments.
With most of our paid focus group studies, you have the option to participate remotely online or in-person. This is a great way to earn additional income from the comfort of your home.
Compensation:
* $5- 150 (per 1 hour session)
* 300- 750 (multi-session studies)
Job Requirements:
* Show up at least 10 mins before discussion start time.
* Participate by completing written and oral instructions.
* Complete written survey provided for each panel.
* MUST actually use products and/or services, if provided. Then be ready to discuss PRIOR to meeting date.
Qualifications:
* Must have either a smartphone with working camera or desktop/laptop with webcam
* Must have access to high speed internet connection
* Desire to fully participate in one or several of the above topics
* Ability to read, understand, and follow oral and written instructions.
* Data entry clerk experience is not necessary.
Job Benefits:
* Flexibility to take part in discussions online or in-person.
* No commute needed should you choose to work from home remotely.
* No minimum hours. You can do this part-time or full-time
* Enjoy free samples from our sponsors and partners in exchange for your honest feedback of their products.
* You get to review and use new products or services before they are released to the public.
You must apply on our website and complete a set of questionnaire to see if you qualify.
This position is perfect for anyone looking for temporary, part-time or full-time work. The hours are flexible and no previous experience is required. If you are a data entry clerk or someone just looking for a flexible part time remote work from home job, this is a great way to supplement your income.
Is this job a match or a miss?
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