CDQA Administrative Analyst

🔥 15 hours ago

🌶️ New Mexico – Remote

🌶️ New Mexico – Remote

💵 $19 - $31 / hour

⏰ Full Time

🟢 Junior

🧐 Analyst

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Presbyterian Healthcare Services

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1908

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • Healthcare Insurance • Non-profit

Presbyterian Healthcare Services is an integrated, nonprofit healthcare system based in New Mexico that operates hospitals, urgent care clinics, specialty and primary care practices, virtual care (VirtualPRES), and health insurance plans. The organization provides a broad range of clinical services—including neuroscience, transplant, cancer care, surgery, behavioral health, and home health—while also running community health and charitable programs (financial assistance, community support, and partnerships with medical education). It offers individual, Medicaid, Medicare Advantage, and employer health plans, plus patient tools (MyChart/myPRES), billing support, and commitment to access and quality across the state.

📋 Description

• Maintain and update enterprise-wide and department coding policies and procedures for PHS • Monitor compliance to external regulatory agency coding rules and regulations • Coordinate internal and external enterprise-wide coding audits across PHS • Summarize and track internal and external audit results • Coordinate and track enterprise-wide training for coding, audit, physician and clinician personnel • Track corrective action plans for identified low performers • Perform medical record and billing reviews of denied and appealed claims • Compile and analyze enterprise-wide coding scorecard metrics for denials, appeals and coding accuracy • Research regulatory agency regulations • Correct patient accounts based on audit findings • Liaise with Information Services, Finance/Patient Financial Services, hospitals, PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and ancillary departments • Maintain accurate, complete and timely documentation • Maintain and disseminate current legal and regulatory information, including ICD-9, CPT-4, HCPCS and APC updates • Research coding, billing and charging compliance issues and implement corrective action plans • Respond to daily coding and auditing inquiries and perform ad-hoc analysis for PHS management • Gather and analyze information and recommend solutions for business issues • Respond to client inquiries by telephone and email • Maintain working knowledge of PHS coding and auditing IT applications • Investigate patient care and billing concerns • Analyze and summarize medical record and account audit data and communicate findings to management • Document inquiry responses and resolutions in information systems • Assist with audit research and documentation

🎯 Requirements

• High school diploma/GED required • One year healthcare clinical, coding, auditing, compliance or patient financial services related experience • Excellent written and verbal communication skills • Detail and results oriented • Ability to work independently • Medical terminology knowledge required • ICD-9/10 knowledge required • CPT-4 knowledge required • HCPCS knowledge required • Must be based in New Mexico • Work shift: Days (United States of America)

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Short-term disability insurance • Long-term disability insurance • Group term life insurance • Other optional voluntary benefits • Employee Wellness rewards program • Gift cards for participating in wellness activities