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

Salary

 

$21.96 - $32.94 Hourly

$45,680 - $68,520 Annually

This position is a Pay Band C5

Posting Details

 
This posting will be used for on-going recruitment and may close at any time. Applicant lists may be screened more than once. New Mexico Rehabilitation Center (NMRC) is a Joint Commission accredited specialty hospital providing rehabilitation services to citizens of the State of New Mexico.

Why does the job exist?

 
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.

How does it get done?

 
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.

Who are the customers?

 
New Mexico Rehabilitation Center patients.

Ideal Candidate

 
The Ideal Candidate for this position will have good communication skills with various disciplines and agency stake holders. This person should be a self-starter and multi-tasker with good time management skills, computer skills, and strong attention to detail.  Candidate should also be familiar with medical terminology and experience working with policies and procedures in a medical, healthcare, or state facility. Ideal candidate will have: Experience with data entry, clinical & monthly reports; Experience in providing comprehensive nursing care; Experience in administration of all types of medications;Experience with policy and procedures; Experience with being compliant with state, federal and The Joint Commission Standards.

Minimum Qualification

 
High school diploma or equivalent and 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 Requirements

 
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).

Working Conditions

 
Work is performed primarily in an office setting with exposure to Visual/Video Display Terminal (VDT) and extensive personal computer to include working with computers, faxes, copiers and printers, and phone usage with extended periods of sitting, standing, bending, squatting, climbing, reaching, kneeling and crawling. Ability to lift up to 25 lbs. Some travel may be required.

Supplemental Information

 

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Agency Contact Information: Mariko Morales, (575) 347-3417, Email

For information on Statutory Requirements for this position, click the Classification Description link on the job advertisement.

Bargaining Unit Position

 
This position is covered by a collective bargaining agreement and all terms/conditions of that agreement apply and must be adhered to.

Date Posted
01/28/2026
Job Reference
160501
Organization
Department of Health, State of New Mexico
Location
Roswell, NM
Category
Project/Program Management
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