Medicare Reporting Specialist

2 weeks ago

Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time
Position Overview

We are currently seeking a Medicare Reporting Specialist for a hybrid role that primarily allows for remote work. This position is essential for the review, compilation, analysis, and auditing of data provided by our business partners for mandatory reporting to the Centers for Medicare & Medicaid Services (CMS).

Our Commitment to Diversity

At Presbyterian, we recognize the importance of diverse perspectives and backgrounds. We believe that our differences strengthen our team and community.

Why Choose Presbyterian?

  • Full-Time Position
  • Located at Rev Hugh Cooper Admin Center
  • Standard Work Hours: Monday to Friday
  • Comprehensive Benefits Package: Medical, wellness programs, vision, dental, paid time off, retirement plans, and more for full-time employees.
Qualifications
  • High School Diploma or GED required.
  • 1-3 years of experience in data compilation for CMS reporting using various technological tools.
  • Proficiency in MS Office Suite, Business Objects, Facets, SharePoint, and Support Point.
  • Preferred background in health plans or Medicare Advantage plans; familiarity with the CMS Health Plan Management System (HPMS) is a plus.
  • Strong analytical skills with the ability to interpret data and solve problems independently or collaboratively.
  • Effective communication skills, both verbal and written, with the ability to negotiate and reach consensus.
  • Excellent time management skills with the ability to multitask and adapt to changing priorities.
Key Responsibilities
  • Ensure timely submission of required reports and marketing materials to CMS in compliance with regulations.
  • Maintain operational compliance with CMS regulations through a structured reporting matrix.
  • Review and submit reports as mandated by CMS.
  • Generate and upload enrollment eligibility files and reports for key business partners, maintaining regular communication across multiple organizational levels.
  • Act as a liaison during the health plan's annual external data validation audit, compiling necessary documentation and updating reporting specifications.
  • Adhere to internal document review processes and manage submissions of marketing and non-marketing materials to CMS.
  • Submit Medicare Advantage member materials, including enrollment and educational resources, through an automated document management tool.
  • Oversee and track business partner communication documents to ensure standardized protocols are followed.
  • Support the preparation and submission of new product applications and annual renewal cycle documents.
  • Assist in the development and revision of departmental policies and procedures.
  • Identify internal improvement opportunities to enhance efficiencies and customer experiences.
  • Provide support to Government Program Medicaid and Education/Outreach teams as directed.
Benefits

All eligible employees at Presbyterian receive a comprehensive benefits package, including medical, dental, vision, short-term and long-term disability, and life insurance, along with optional voluntary benefits.

Wellness Initiatives

Our Employee Wellness rewards program offers engaging opportunities to enhance your health and well-being, including wellness challenges and preventive screenings.

About Presbyterian Healthcare Services

Presbyterian is dedicated to improving the health of our patients, members, and communities. As a locally owned, not-for-profit healthcare system, we are the largest private employer in New Mexico, with a diverse workforce committed to making a positive impact.

Inclusion and Diversity

We foster a culture of respect and understanding for our patients, members, and each other, reflected in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer.

  • Medicare Reporting Specialist

    2 weeks ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Position OverviewWe are currently seeking a Medicare Programs Report Specialist. This position operates in a hybrid environment, primarily allowing remote work.The individual will be tasked with the examination, aggregation, analysis, and auditing of data sourced from business collaborators for mandatory reporting required by the Centers for Medicare &...

  • Medicare Reporting Analyst

    2 weeks ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Position OverviewWe are seeking a Medicare Programs Report Specialist for a hybrid work opportunity, primarily remote. This role is essential for the analysis and audit of data provided by our business partners, ensuring compliance with the Centers for Medicare & Medicaid Services (CMS) mandatory reporting requirements.Our Commitment to DiversityAt...

  • Medicare Wellness LPN/LVN

    4 days ago

    Albuquerque, New Mexico, United States Duke City Urgent Care Full time

    Job SummaryWe are seeking a skilled LPN/LVN to join our team at Duke City Urgent Care as a Medicare Wellness LPN/LVN. In this role, you will be responsible for performing Medicare Wellness visits with identified patients, collaborating with providers for documentation and review, and providing patient education on chronic disease management and preventative...

  • HR Reporting Specialist

    6 days ago

    Albuquerque, New Mexico, United States Prime Therapeutics Full time

    Job SummaryThe HR Reporting Specialist is a key member of the Prime Therapeutics team, responsible for supporting the company's talent analytics strategies by providing data and reporting products and services. This role is critical in creating and executing multiple reporting products and processes in support of the broader Analyst team.Key...

  • Financial Reporting Specialist

    1 week ago

    Albuquerque, New Mexico, United States Jobot Full time

    Become a key member of our dynamic finance team as a Senior Accounting SpecialistAt Jobot, we are a thriving organization dedicated to providing exceptional benefits and opportunities for career growth. This is an outstanding opportunity for a meticulous professional to demonstrate their accounting expertise in a fast-paced and innovative setting. You will...

  • Healthcare Reception Specialist

    2 weeks ago

    Albuquerque, New Mexico, United States El Centro Family Health Full time

    Position Overview:As a Federally Qualified Health Center, our commitment is to deliver affordable and accessible quality healthcare to the residents of Northern New Mexico. El Centro Family Health is on the lookout for a full-time Healthcare Reception Specialist who is passionate about community service and dedicated to promoting wellness and quality...

  • Senior Services Quality Assurance Specialist

    4 hours ago

    Albuquerque, New Mexico, United States Ambercare Full time

    Job Summary: Ambercare is seeking a highly skilled Senior Services Quality Assurance Specialist to join our team. As a key member of our organization, you will be responsible for ensuring the highest level of quality in our senior services.Key Responsibilities:Conduct in-home visits to monitor and report on the quality of services provided by Home Care...

  • Revenue Cycle Operations Specialist

    2 weeks ago

    Albuquerque, New Mexico, United States UNM Medical Group, Inc. Full time

    Job OverviewUNM Medical Group, Inc. is seeking a Revenue Cycle Operations Specialist to enhance our Revenue Cycle department. This is a full-time position with day shift hours.Compensation: Minimum $38,916 - Midpoint $48,651**Salary is contingent upon years of relevant experience.*Salary is based on a full-time equivalent (1.0 FTE) or 40 hours per week....

  • Medical Admissions Specialist

    2 weeks ago

    Albuquerque, New Mexico, United States Ensemble Health Partners Full time

    Thank you for considering a career at Ensemble Health Partners. Ensemble Health Partners is a premier provider of technology-driven revenue cycle management solutions for healthcare systems, including hospitals and associated physician groups. They deliver comprehensive revenue cycle solutions along with a wide array of specialized services to clients...

  • Patient Account Specialist

    2 weeks ago

    Albuquerque, New Mexico, United States UNM Hospitals Full time

    Department: Patient Financial Services - UNM HospitalsFTE:0.75 Full TimeShift: DaysBilingual English/Spanish PreferredPosition Overview: The Patient Account Specialist is accountable for managing all functions related to patient accounts receivable as designated. This includes reconciling, investigating, correcting, and submitting claims to third-party...

  • Patient Intake Specialist

    1 week ago

    Albuquerque, New Mexico, United States HME Specialists LLC Full time

    Job OverviewHME Specialists LLC is in search of a motivated Patient Intake Specialist to enhance our pharmacy operations. This role requires in-person engagement.Position Summary:The selected candidate will be tasked with confirming insurance benefits for specialized medications and services, as well as managing and monitoring authorization requests....

  • Rehabilitation Specialist

    2 weeks ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Position OverviewOpportunity Type: Full TimeEmployment Status: Exempt: NoWork Schedule: Daytime Hours*Sign-on Bonus and relocation assistance available for eligible candidates*Your well-being is our priority. At Presbyterian, we offer a vibrant and engaging wellness program that includes complimentary access to on-site and community fitness facilities,...

  • Financial Reporting Analyst

    2 weeks ago

    Albuquerque, New Mexico, United States Nexstar Broadcasting Full time

    The Senior Accounting Specialist plays a crucial role in supporting the Accounting Department at Nexstar Broadcasting by engaging in various activities related to the monthly financial closing process. This includes evaluating the financial results of multiple television stations, preparing monthly journal entries, adhering to internal SOX compliance, and...

  • Rehabilitation Specialist

    2 weeks ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Position OverviewType of Opportunity: As NeededFTE:0.Exempt:NoWork Schedule: Flexible Days and Hours*Roles available in various locations*At Presbyterian, we prioritize well-being, starting with our employees.Our team members benefit from an engaging wellness program that includes complimentary access to on-site and community gyms, nutrition coaching,...

  • Senior Care Specialist

    1 day ago

    Albuquerque, New Mexico, United States Ambercare Full time

    Job Summary:This position will be responsible for conducting in-home visits at clients' homes to monitor and report on the quality of services being provided by Home Care Aides, and to determine whether existing care plans are adequate to meet client needs.Key Responsibilities:Monitor client's condition and performance of duties by Home Care AidesMaintain...

  • Senior Care Specialist

    5 days ago

    Albuquerque, New Mexico, United States Ambercare Full time

    Job Summary:This position will be responsible for conducting in-home visits at clients' homes to monitor and report on the quality of services being provided by Home Care Aides, and to determine whether existing care plans are adequate to meet client needs.Key Responsibilities:Monitor client's condition and performance of duties by Home Care AidesMaintain...

  • Home Care Quality Assurance Specialist

    6 days ago

    Albuquerque, New Mexico, United States Addus HomeCare Corporation Full time

    Job Summary:This position is responsible for conducting in-home visits to monitor and report on the quality of services provided by Home Care Aides, ensuring that client care plans are adequate and effective.Key Responsibilities:Monitor client conditions and performance of duties by Home Care AidesMaintain all company and regulatory standards, rules, and...

  • Pediatric Gastroenterology Specialist

    2 weeks ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Pediatric Gastroenterology Specialist – Location Not Specified At Presbyterian Healthcare Services, our approach to healthcare is what sets us apart. Our commitment to excellence is evident in every aspect of our practice.We are dedicated to providing safe, high-quality medical care, and we invite you to be part of a team that makes a significant impact on...

  • Senior Quality Assurance Specialist

    4 days ago

    Albuquerque, New Mexico, United States Ambercare Full time

    Job DescriptionJob Summary:This position will be responsible for conducting in-home visits at clients' homes to monitor and report on the quality of services being provided by Home Care Aides, and to determine whether existing care plans are adequate to meet client needs.Key Responsibilities:Monitor client's condition and performance of duties by Home Care...

  • Experienced Internal Medicine Specialist

    2 weeks ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Presbyterian Healthcare Services, a community-focused, not-for-profit healthcare organization in New Mexico, is in search of a BE/BC Internal Medicine physician to become part of our expanding team of dedicated clinicians and support staff in Albuquerque, NM.Practice FeaturesEach primary care facility in Albuquerque and Belen is equipped with on-site...