117 coder jobs found in Santa Fe

Company : Highmark Inc. Job Description : JOB SUMMARY This job plans, develops, and maintains operational processes and reporting related to group/provider facility and professional reimbursement configurations and other operational processes. Acts as the primary liaison between provider contracting, provider reimbursement, and claims experience. Collaborates with the pricing team to troubleshoot reimbursement issues and works with the Reimbursement Policy and Compliance team team to develop and maintain effective reimbursement quality programs and reporting. ESSENTIAL RESPONSIBILITIES Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have...

Company : Highmark Inc. Job Description : JOB SUMMARY The incumbent is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse. Must be able to testify in a court of law, prepare cases for referral to various...

Sr. Distinguished Machine Learning Engineer (Remote-Eligible) Overview: At Capital One, we are creating responsible and reliable AI systems, changing banking for good. For years, Capital One has been an industry leader in using machine learning to create real-time, personalized customer experiences. Our investments in technology infrastructure and world-class talent - along with our deep experience in machine learning - position us to be at the forefront of enterprises leveraging AI. From informing customers about unusual charges to answering their questions in real time, our applications of AI & ML are bringing humanity and simplicity to banking. We are committed to continuing to build world-class applied science and engineering teams to deliver our industry leading capabilities with breakthrough product experiences and scalable, high-performance AI infrastructure. At Capital One, you will help bring the transformative power of emerging AI capabilities to reimagine how...

Job Description Responsible for designing, developing, and maintaining user assistance and training documentation for Oracle applications. Collaborate with multiple internal stakeholders to design our next generation of user assistance technology and implementing new embedded help delivery mechanisms that improve how technical information is delivered to our customers. Work with development teams to implement code for new user assistance mechanisms. Design and develop high-quality training content for data center systems, including mechanical (CRAHs, chillers), electrical (UPS, generators), and controls systems (BAS, BMS, protocols like BACnet and Modbus). Create learning assets such as eLearning modules, instructor-led training guides, job aids, assessments, animations, and simulations tailored to data center operations and technician training. Collaborate with SMEs and engineering teams to gather technical input and ensure accuracy, clarity, and relevance of content....

Why UKG: At UKG, the work you do matters. The code you ship, the decisions you make, and the care you show a customer all add up to real impact. Today, tens of millions of workers start and end their days with our workforce operating platform. Helping people get paid, grow in their careers, and shape the future of their industries. That's what we do. We never stop learning. We never stop challenging the norm. We push for better, and we celebrate the wins along the way. Here, you'll get flexibility that's real, benefits you can count on, and a team that succeeds together. Because at UKG, your work matters-and so do you. About the Team: Our Sales organization has experienced tremendous growth quarter over quarter! We take great pride in having the highest employee engagement in the company. There is long term success and tenure on the team with experienced leadership. With UKG's aggressive compensation plans and global President's Club trips, our top reps are...

Company : United Concordia Dental Job Description : JOB SUMMARY This job services United Concordia Dental's (UCD's) clients by recruiting, training and servicing quality dental networks in assigned territory in a remote and mobile work environment. Manage network contracts including negotiations, contract development/renewal and financial reimbursement. Meet with dentists and office personnel to act as the intermediary between the organization and UCD. Respond to contractual and payment issues both internally and externally. Ensure compliance with contractual terms through regular on-site audits. Apply an active role in network management, training, monitoring and enforcement of company policies and procedures while increasing provider efficiencies. ESSENTIAL RESPONSIBILITIES Identify and initiate contact with prospective providers. Develop and follow up on leads in an established time frame, while incorporating a sound business plan strategy to support and...

Job Description Remote: This position does not require the employee to be on-site full-time to perform most effectively. The employee's role enables them to work off-site on a permanent basis. This position requires an employee to cover territory visits to dealerships in a reoccurring frequency. The territory covers dealerships within the Northeast Region, including Maine, Vermont, New Hampshire, New York, Connecticut, Rhode Island, Massachusetts, New Jersey, and Pennsylvania. The selected candidate must live within the territory, defined as any of the listed states, or relocate into the territory. Relocation may be provided. The Role The Team Leader of the GM Field Service Engineers (FSEs) oversees the team, focusing on personnel management, training, and daily operations to ensure optimal performance. What You'll Do Achieve performance goals through CAP objective development and employee reviews. Provide monthly performance updates (FSE Dashboard)....

Animal Protection of New Mexico, Inc. “Animal Advocacy Organization” Full Time Albuquerque and Santa Fe, New Mexico Applications have closed Animal Protection of New Mexico, Inc. Job Overview Reporting: Program and Logistics Associate reports to Program Manager; no positions report to Program and Logistics Associate. Summary of Position Position Responsibility: To bring about systemic change for animals in New Mexico by supporting and assisting with the planning and execution of APNM’s effective program, administrative, and development efforts through research, initial data analysis, correspondence, community organizing, volunteer coordination, Santa Fe physical office support, and back-up coverage for the animal cruelty hotline. Position Objectives: Provide support for APNM’s legislative and non-legislative policies and programs Provide support for APNM’s development and administration efforts Conduct research,...

Team Leader Req number: R7463 Employment type: Full time Worksite flexibility: Remote Who we are CAI is a global services firm with over 9,000 associates worldwide and a yearly revenue of $1.3 billion+. We have over 40 years of excellence in uniting talent and technology to power the possible for our clients, colleagues, and communities. As a privately held company, we have the freedom and focus to do what is right-whatever it takes. Our tailor-made solutions create lasting results across the public and commercial sectors, and we are trailblazers in bringing neurodiversity to the enterprise. Job Summary We are looking for a motivated Project Manager ready to take us to the next level! If you have 10+ years of IT experience, with demonstrated knowledge in the development and maintenance of custom Business applications, and are looking for your next career move, apply now. Job Description We are looking for an IT Team Leader to join our...

Company : Highmark Health Job Description : JOB SUMMARY Candidates residing within 50 miles of our Pittsburgh office are required to work onsite Tuesday through Thursday. This job supports Enterprise Transformation project teams in delivering day-to-day client service and analytical support. The incumbent collaborates across 1-2 client teams at a time and is responsible for uncovering, synthesizing, analyzing and presenting critical information, supporting the team to identify insights and shape recommendations. Beyond establishing the fact base, the incumbent forms a clear point of view to share back with team and the client. This job is expected to consistently provide excellent customer service to business units in a supporting team role. ESSENTIAL RESPONSIBILITIES Complete project deliverables under the direction of leadership, including gathering and analyzing qualitative and quantitative information, testing hypotheses, building presentations and...

Sr. Distinguished Machine Learning Engineer (Remote-Eligible) Overview: At Capital One, we are creating responsible and reliable AI systems, changing banking for good. For years, Capital One has been an industry leader in using machine learning to create real-time, personalized customer experiences. Our investments in technology infrastructure and world-class talent - along with our deep experience in machine learning - position us to be at the forefront of enterprises leveraging AI. From informing customers about unusual charges to answering their questions in real time, our applications of AI & ML are bringing humanity and simplicity to banking. We are committed to continuing to build world-class applied science and engineering teams to deliver our industry leading capabilities with breakthrough product experiences and scalable, high-performance AI infrastructure. At Capital One, you will help bring the transformative power of emerging AI capabilities to reimagine how...

Sumitomo Pharma Co., Ltd., is a global pharmaceutical company based in Japan with operations in the U.S. (Sumitomo Pharma America, Inc.), focused on addressing patient needs in oncology, urology, women's health, rare diseases, cell & gene therapies and CNS. With several marketed products and a diverse pipeline of early- to late-stage investigational assets, we aim to accelerate discovery, research, and development to bring novel therapies to patients sooner. For more information on SMPA, visit our website https://www.us.sumitomo-pharma.com or follow us on LinkedIn. We are currently seeking a dynamic, highly motivated, and experienced individual for the position of Sales Account Manager, Oncology for the Salt Lake City, Utah territory. Preference to candidates who live in the Salt Lake City metro area, with consideration to candidates living in the Las Vegas metro area. In this field-based role, the Prostate Cancer Sales Specialist will focus on achieving sales goals...

Sr Lead Software Engineer, Full Stack AI MCP - Shopping (Remote-Eligible) Do you love building and pioneering in the technology space? Do you enjoy solving complex business problems in a fast-paced, collaborative, inclusive, and iterative delivery environment? At Capital One Shopping, you'll be part of a big group of makers, breakers, doers and disruptors, who love to solve real problems and meet real customer needs. We are seeking a Senior Lead Software Engineer who is passionate about marrying data with emerging technologies. As a full stack engineer focusing on AI, you'll have the opportunity to be on the forefront of driving a major transformation within Capital One Shopping. What You'll Do: Be a hands-on leader driving the development of next-generation AI solutions for the future of shopping. Share your passion for staying on top of tech trends, experimenting with and learning new technologies, participating in internal & external technology...

Job Title Sr. Procurement Manager Job Description Summary The Senior Procurement Manager is responsible for leading the procurement function within the portfolio of sites on a client account. This role involves developing and executing procurement strategies, leading strategic sourcing, ensuring the cost-effective procurement of goods and services, building strong relationships with internal and external stakeholders, developing effective working relationships with suppliers, implementing operational efficiencies, and managing supplier performance. This position is client-facing and highly visible to internal & external stakeholders. Job Description Our Core Values Driven: We celebrate determination in pursuit of excellence. Resilient: We navigate uncertainty with courage and adapt to deliver impactful outcomes. Inclusive: We value curiosity and collaboration. We seek out different perspectives, listen actively and turn feedback into...

Company : Highmark Inc. Job Description : JOB SUMMARY This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent will be supported by a multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources. In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are enrolled in case management. The incumbent conducts outreach to members enrolled in case management including but is not limited to: developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate...

Lead Software Engineer, Systematics (Remote) We are looking for a Lead Software Engineer (Mainframe, Systematics) to join and lead our team. We have engineers that have systems, Mainframe, and software engineering backgrounds. The software engineering role within Capital One is critical to our success and one that focuses on building a highly reliable, scalable and measurable customer experience ensuring continued growth of Capital One's critical services in the Bank. What You'll Do: You will be responsible for guiding software engineers on the systematics team responsible for the definition, design, construction, integration, testing, and support of reliable and reusable software solutions, addressing business opportunities Includes systems analysis, creation of specifications, coding, testing, and implementation of application programs and data interfaces Develop complex applications using GN/IM/RM/MA application experience and Agile Requires...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for screening, reviewing, evaluating online entry, correcting errors and/or performing quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Reviews processed claims and inquiries to determine corrective action including adjusting claims as necessary and takes the corrective action steps using enrollment, benefit and historical claim processing information; may coordinate benefits and interact with customers. Responsible for the timely and accurate completion of claims adjustments which could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals, and system changes, etc.; provides technical assistance in researching and resolving inquiries. ESSENTIAL RESPONSIBILITIES Receives and processes complex...

Sumitomo Pharma Co., Ltd., is a global pharmaceutical company based in Japan with operations in the U.S. (Sumitomo Pharma America, Inc.), focused on addressing patient needs in oncology, urology, women's health, rare diseases, cell & gene therapies and CNS. With several marketed products and a diverse pipeline of early- to late-stage investigational assets, we aim to accelerate discovery, research, and development to bring novel therapies to patients sooner. For more information on SMPA, visit our website https://www.us.sumitomo-pharma.com or follow us on LinkedIn. We are currently seeking a qualified, highly motivated, experienced individual for the position of Regional Sales Director, Prostate Cancer (Great Lakes). The position reports to the Senior Area Sales Director. The location of the position is field based. Candidates must live within territory, with a preference for candidates who live near Pittsburgh, Cleveland, Columbus, or Detroit . The Regional Sales...

Why UKG: At UKG, the work you do matters. The code you ship, the decisions you make, and the care you show a customer all add up to real impact. Today, tens of millions of workers start and end their days with our workforce operating platform. Helping people get paid, grow in their careers, and shape the future of their industries. That's what we do. We never stop learning. We never stop challenging the norm. We push for better, and we celebrate the wins along the way. Here, you'll get flexibility that's real, benefits you can count on, and a team that succeeds together. Because at UKG, your work matters-and so do you. About the Team: UKG's Healthcare team is seeking a Mid-Market New Account Executive. The Healthcare vertical is full of talented, collaborative team members that work closely to align customer and prospect goals with UKG products. This person will be tasked with creating and maintaining key stakeholder relationships, in the accounts, and maximize...

Why UKG: At UKG, the work you do matters. The code you ship, the decisions you make, and the care you show a customer all add up to real impact. Today, tens of millions of workers start and end their days with our workforce operating platform. Helping people get paid, grow in their careers, and shape the future of their industries. That's what we do. We never stop learning. We never stop challenging the norm. We push for better, and we celebrate the wins along the way. Here, you'll get flexibility that's real, benefits you can count on, and a team that succeeds together. Because at UKG, your work matters-and so do you. The Principal, Global BDR Enablement role is responsible for supporting and enhancing the performance of the BDR's and provides a point of coordination for go-to-market leadership. The position requires a deep understanding of selling, sales leadership, methodologies, processes, and selling tools. It also requires an understanding of how people learn and...

Job Description As the Senior Director of Colocation Infrastructure Construction Delivery, you will be at the forefront of shaping the future of our data infrastructure. Your leadership will be pivotal in driving the strategic vision for our data center projects, ensuring they align with our long-term organizational goals. You will lead a dynamic team of professionals, fostering a culture of innovation, collaboration, and excellence. Your role will involve not only overseeing the successful execution of complex construction projects but also inspiring your team to push the boundaries of what's possible in data center design and construction. Strategically, you will be responsible for developing and implementing comprehensive plans that optimize efficiency, cost-effectiveness, and operational excellence in delivery. You will engage with key stakeholders, manage high-stakes vendor relationships, and navigate the complexities of regulatory compliance. Your ability to...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: The director of Physician Organization Analytics will lead the strategic development and delivery of comprehensive, accurate, and timely physician organization reporting packages. This pivotal role is responsible for establishing a "single source of truth" for key performance indicators (KPIs) and operational insights, empowering physician leaders to make data-driven, real-time decisions with unwavering trust in the underlying data. The Director will drive the alignment of reporting to Epic and industry-standard definitions, ensuring consistency and credibility. A critical aspect of this role involves close partnership with clinical, operational, and administrative stakeholders to validate data accuracy and relevance. This leader will oversee physician organization operational benchmarking, patient access reporting and analytics, and provide data and analytic support to the physician organization...

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Pharmacy Trade Relations Analyst Sr - Remote Job Description The Senior Trade Relations Analyst is responsible for performing multifaceted financial analyses to assess manufacturer contract performance, plan performance and to develop rebate estimates related to pharmaceutical rebate agreements. This position is also responsible for developing recommendations based on financial analysis results. Responsibilities Assist the contract negotiators in providing financial analyses of manufacturer rebate proposals and operations including sensitivity analyses, competitive offer assessments, performance tracking and scenario building Research, compile, and analyze rebate pricing and trending data for client facing...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for supervising member service call center and ensuring timely, professional, and courteous responses to all customer inquiries and complaints, appropriately referring inquiries to other areas as necessary for resolution. Investigate escalated member inquiries. The incumbent may be required to make routine medical approval decisions. ESSENTIAL RESPONSIBILITIES Manage the departmental operations and day-to-day functions. Handle escalated calls from members, state agencies, providers and vendors. Coach and counsel employees. Prepare reports for various internal and external areas for trends and statistics. Create and maintain quality and training programs for department. Responsible for on-call emergency contact for nights and weekend support. Other duties as assigned or requested. QUALIFICATIONS Minimum High School Education or...