Presbyterian Healthcare Services

• Codes inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services • Ensures adherence to Hospital and Departmental Policies and Procedures • Reviews patients' entire current medical record, assigning appropriate codes • Abstracts data for QI department • Resolves any pre-bill edits, denials, etc for assigned accounts • Maintains up-to-date technical knowledge of legal and regulatory information • Participates in departmental in-services and updates • Demonstrates knowledge of coding multiple areas

• Reviews patients entire current medical record, assigning appropriate codes including CPT, ICD and MS-DRG (as defined by UHDDS guidelines and CMS) to be used for financial reimbursement, research in accordance with Federal Regulations and Hospital and Departmental policies. • Abstracts data essential to the QI department in determining patient care issues as well as providing information to The Joint Commission. • Accesses several systems via the computer to research the medical record when needed to complete the coding in a timely manner. • Takes responsibility for accounts receivable by looking for lost documents to insure all encounters are coded, including the generation of appropriate queries, as needed. • Responsible for resolving any and all pre-bill edits, denials, etc for assigned accounts. • Maintains and disseminates up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area. This includes but is not limited to all ICD-9/10 CM, CPT-4, HCPCS, DRG, APC and/or HHRG updates and changes. • Participates in all departmental in-services and updates to stay current with the accepted coding guidelines and improve personal knowledge of medicine and treatment. • Communicates issues to the EW Clinical Coding Manager & Supervisor, as appropriate. • Must demonstrate knowledge of coding multiple areas of service and/or specialties. • Maintains at least a 95% accuracy rate. • Maintains average to high productivity based on PHS Productivity Standards. • Maintains continuing education (CE) requirements per PHS policy

Role Description Presbyterian is seeking a Nurse Advice Line - Clinical Triage. The Nurse Advice Line performs clinical triage and review of inbound member and patient calls to the PHP Nurse Advice Line to ensure that services rendered to customers meet clinically appropriate direction and triage. Utilizes clinical skills to coordinate, document, and communicate all aspects of the appropriate clinical advice and triage based on criteria and in adherence to adopted protocols. Clinical triage includes all levels of acuity of medical presentations. Assists callers and members with coordination of care to in plan providers and appropriate urgent and emergent care. Validates and interprets medical information from callers using evidence-based criteria sets. Consults with PHP medical directors on non-emergent cases where protocols are not clear. Refers callers of various acuities to venues of care-- including primary care, urgent or emergent care, ALS services, or public health services such as Poison Control Center or Public Health Department. May work varied shifts and performs occasional on-call assignments. - Receives, triages, verifies, and processes requests for clinical triage and medical advice from health plan members and their representatives. - Uses clinical protocols to assess advice to callers, and documents discussion and information relayed. - May work with stakeholders and primary and specialty providers across the state to identify most appropriate direction of care based on call. - Uses critical thinking to gauge risks, determine acuity of caller's situation and make evidence-based decisions on information and advice provided. - Legally documents all calls and information discussed. Records and refers all pertinent information accordingly. - May collaborate with other resources such as behavioral health clinicians or crisis staff to best direct callers. - Advises manager of trends in calls and potential quality of care and legal issues. - Communicates effectively with providers, PHP medical directors, PCSC staff, and other applicable PHS departments to deliver sound and appropriate advice. Qualifications - Associates degree. - New Mexico Board of Nursing RN License with Multi-State Compact Licensure status required. - At least 3 years of RN experience in clinical setting, emergency medicine, urgent care, or managed care experience. - Experienced analytical skills as applicable to interpret medical records. - Experience with detailed research, coordination and organizational skills. - Demonstrated critical thinking skills as evidenced by experience, education, and/or the pre-hire interview process. Requirements - Part time opportunity (FTE: 0.50). - Work shift: Evenings (United States of America). Benefits - Educational and career development options, including tuition and certification reimbursement, scholarship opportunities. - Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern). - Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions). - Malpractice liability insurance. - Loan forgiveness through the New Mexico Higher Education Department. - EPIC electronic charting system.

Role Description Build your Career. Make a Difference. Presbyterian is hiring a skilled Medical Economics Analyst-Payment Integrity to join our team. The Payment Integrity Medical Economics Analyst plays a critical role in identifying, quantifying, and validating medical cost savings opportunities through deep partnership with the Payment Integrity team. This role combines advanced analytics, claims validation, and financial insight to ensure accuracy of payments, integrity of savings initiatives, and alignment to total cost of care (TCOC) objectives. This individual will leverage enterprise data assets, including claims and provider data, to produce actionable insights, validate recoveries, and support pre- and post-pay integrity initiatives. The role requires strong technical expertise (SQL/SAS), comfort working with large healthcare datasets, and the ability to translate findings into clear financial impact. - Partner closely with Payment Integrity, Operations, and vendor partners (e.g., Cotiviti, Optum) to support pre-pay and post-pay initiatives - Analyze claims data to identify patterns of overpayment, billing anomalies, and coding discrepancies - Support development and refinement of rules, algorithms, and audit strategies to improve payment accuracy - Translate operational PI activities into measurable financial outcomes tied to TCOC - Validate identified savings opportunities through detailed claims-level analysis and audit review - Develop and maintain methodologies to quantify gross and net savings (pre-pay edits, post-pay recoveries, avoidance) - Perform before/after and control group analyses to ensure credibility of savings estimates - Partner with finance to align validated savings with general ledger and financial reporting - Extract, transform, and analyze large-scale healthcare datasets using SQL, SAS, or similar tools - Work within enterprise data warehouse environments to build repeatable datasets and analytic pipelines - Develop dashboards and reporting tools to monitor payment integrity performance and trends - Support integration of external/vendor outputs into internal analytics frameworks - Produce clear, concise reporting on payment integrity performance, savings, and emerging opportunities - Develop executive-ready summaries highlighting key drivers, risks, and recommended actions - Support ongoing monitoring of initiative performance and identification of new opportunities - Generate pre-payment edit contribution invoices for Self-Funded accounts Qualifications - Bachelor’s degree in Actuarial Science, Economics, Finance, Data Analytics, Healthcare Administration, or related field (or equivalent experience) - 2–5+ years of experience in healthcare analytics, medical economics, or payment integrity - Strong technical skills in SQL and/or SAS (required); experience querying large relational databases - Experience working with claims data and reimbursement methodologies (fee schedules, IPPS, OPPS) - Demonstrated ability to perform financial and statistical analysis on large datasets - Strong problem-solving skills with attention to detail and data accuracy Benefits - Comprehensive benefits package including medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits - Employee Wellness rewards program designed to provide engaging opportunities to enhance health and activate well-being

Role Description Build your Career. Make a Difference. Presbyterian is hiring a skilled Medical Economics Lead Analyst-Network Strategy to join our team. The Med Econ Lead Analyst, Network Strategy plays a critical role in supporting provider contracting and network strategy through advanced financial analytics, benchmarking, and actionable insights. This individual partners closely with Network Strategy, Finance, and Medical Economics leadership to evaluate contract performance, model renegotiation scenarios, and deliver decision-ready insights that directly impact total cost of care and margin performance. This role blends deep analytical rigor with business acumen, translating complex data into clear, actionable recommendations that inform high-stakes provider negotiations. - Lead financial modeling to support provider contract renegotiations, including unit cost analysis, reimbursement benchmarking, and scenario modeling - Quantify expected savings / impact of proposed contract changes (rate changes, value-based arrangements, risk structures) - Develop pre-negotiation targets and guardrails grounded in internal performance and external benchmarks - Partner with Network Strategy to support negotiation strategy with data-driven narratives and insights - Build and maintain provider performance benchmarks (cost, utilization, quality where applicable) - Compare network performance against market, internal, and best-in-class benchmarks - Identify outliers and opportunities to inform network strategy priorities - Support development of strategic partnership dashboards used by Network and executive leadership - Translate analytics into clear, actionable insights, not just reporting - Design and deliver executive-ready dashboards tracking: Contract performance vs. expectations, Savings realization vs. targets, Network unit cost and utilization trends - Validate and track realized savings from contract changes and network initiatives - Partner with broader Med Econ / Finance teams to ensure alignment on methodologies and financial impact - Support ad hoc analyses related to network strategy, affordability, and TCOC initiatives Qualifications - Bachelor’s degree in Finance, Economics, Data Analytics, Actuarial Science, or related field (or equivalent experience) - 5–8+ years of experience in healthcare analytics, actuarial, medical economics, or network strategy - Experience working with Claims data and total cost of care drivers - Strong understanding of Provider contracting and reimbursement methodologies - Proven ability to build financial models and translate results into business decisions - Experience working with cross-functional stakeholders (network, finance, clinical) - Advanced proficiency in Excel, SQL, and/or data visualization tools (Power BI, Tableau) Benefits - Comprehensive benefits package including medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits - Employee Wellness rewards program designed to provide engaging opportunities to enhance health and activate well-being Company Description Presbyterian exists to improve the health of patients, members, and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan, and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses. - Our health plan serves more than 580,000 members statewide - Offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans

Title: Provider Network Management Relations Executive Location: Remote Workers New Mexico, Work Type:Remote, Full Time Job ID: 4771 Job Description: Location Address: Remote Office Santa Fe, NM 87501 Compensation Pay Range: Minimum Offer $51,209.60 Maximum Offer $78,166.40 Now Hiring: Provider Network Management Relations Executive Summary: Build your Career. Make a Difference. Presbyterian is hiring a skilled Provider Network Management Relations Executive to join our team. Type of Opportunity: Full time Job Exempt: Yes Job is based: Remote Workers New Mexico Work Shift: Days (United States of America) Responsibilities: Presbyterian Healthcare is seeking a Provider Network Management Relations Executive. Provides oversight of network strategies and relationship development activities for assigned providers including individualized planning, training and development of providers to align with Presbyterian s clinical quality initiatives. Will provide the framework for physician/provider performance reporting that will assist providers with objective and quantitative analysis of clinical quality performance measures. The Network Relations Service Executive is a professional accountable for proactively identifying issues, resolving disputes, and coordinating resolutions. Accountable for resolving complex problems, fielding general questions, and acting as a liaison between the provider of service and the health plan. Some key responsibilities include: - Collaborates and maintains relationships with providers and staff throughout Presbyterian to ensure an exceptional provider experience. - Develops and maintains cooperative working relationships between PHP, institutional provider and individual providers. - Provides education on quality initiatives, managed care, capitation, products, policies and procedures, reimbursement issues, referral/authorization process, etc. - Responsible for ensuring provider data integrity and accuracy by ensuring PIF s are completed timely and accurately and through a comprehensive review and validation of provider directory data. - Responsible for post payment validation of assigned providers to ensure accuracy of payment to the contract and corresponding fee schedules. - Resolves provider issues - claims, health services, finance, etc. - Stimulates and fosters professional development of the Network Relations Service Associates. - Supports Network Contracting strategies in an effort to preserve a robust provider network. - Serves as primary liaison between the provider and the health plan. - Maintains a general knowledge of health plan reimbursement methodologies. - Conducts provider visits based on established departmental goals, which will require 50-65% field contact. - Engages and supports leadership and peers by promoting and participating in department initiatives and being accountable for achieving business objectives. Qualifications: - Three years experience in provider relations, provider contracting, claims processing, or customer service in a healthcare organization. Strong working knowledge of risk sharing programs and different reimbursement methodologies i.e. capitation, DRG, Relative Value Systems, etc. Must demonstrate strong verbal, written communication, and presentation skills with strong interpersonal and negotiations skills and ability to interface with providers. Must also possess strong facilitation, organizational, and personal computing skills - Education: Essential: High School Diploma or GED All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more. Why work at Presbyterian? As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

• The Finance Strategy Analyst reports to the Director of Budget and Forecasting and is a PHS enterprise strategic financial analyst role. • Performs financial analyses and forecasting pertaining to ongoing performance. • Creates financial models for financial viability analyses for new and expanded services and equipment. • Analyzes business challenges/problems requiring strategic planning effort, compilation of data from a wide variety of source systems. • Works with stakeholders on NPV development for capital projects. • Prepares complex financial modeling and calculations, interpretation of results and preparation of presentation materials to senior leadership and other PHS consumers of information and analyses. • Competent with using the Enterprise Resource Planning software applications for Long Range Financial Planning, Forecasting, Capital Planning, Operating Budget, reporting and report development. • Supports the Long-Range Financial Planning process by quantifying strategic and operational initiatives. • Works with stakeholders on collecting the necessary data to perform Net Present Value (NPV) calculations for capital projects under consideration. • Determines data needs/construct and interface with Data and Analytics or IT partners to compile the necessary data to perform enterprise-wide analyses. • Participates in the design and development of financial reports and dashboards. • Performs ad-hoc analyses as requested.

• Code all of the following: inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services • Ensure adherence to Hospital and Departmental Policies and Procedures • Review patients entire current medical record, assigning appropriate codes including CPT, ICD and MS-DRG • Access several systems via the computer to research the medical record when needed • Take responsibility for accounts receivable by looking for lost documents • Maintain and disseminate up-to-date technical knowledge of legal and regulatory information • Responsible for resolving any and all pre-bill edits, denials, etc. • Participate in all departmental in-services and updates

• Support and optimize payroll functionality within Workday • Ensure payroll operations remain accurate, compliant, and stable in a healthcare environment • Serve as the primary resource for troubleshooting payroll issues, supporting payroll processing, configuring Workday Payroll components • Manage testing and release impacts, supporting reporting needs, and coordinating cross-functional dependencies with HR, Finance, IT, Clinical teams, and external partners • Act as a primary point of contact for system troubleshooting, root cause analysis, and resolution of Workday Payroll issues impacting daily operations and payroll processing cycles • Provide best practice guidance and consulting support to Payroll, HR, Finance, and IT stakeholders to drive process efficiency and operational improvement. • Advise Payroll stakeholders on business process design options, risks, and best-practice solutions • Configure and maintain Workday Payroll components including earnings, deductions, pay groups, pay period schedules, payroll calendars, run categories, and related business process workflows • Execute and support payroll processing activities (on-cycle and off-cycle) • Create, load, validate, and troubleshoot Payroll EIBs • Partner with Finance and Accounting teams to support payroll-to-GL reconciliation and resolution of costing, posting, or allocation issues • Develop and maintain Workday reports and dashboards to support payroll operations, compliance, and leadership decision-making • Collaborate with stakeholders to align reporting needs with Workday’s standard delivered reporting capabilities

• Code all inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services • Ensure adherence to Hospital and Departmental Policies and Procedures • Demonstrate knowledge of coding multiple areas of service and/or specialties or extensive experience in a specific specialty • Review patients' entire current medical record, assigning appropriate codes including CPT, ICD and MS-DRG • Access several systems via the computer to research the medical record to code in a timely manner • Take responsibility for accounts receivable by looking for lost documents • Maintain and disseminate up-to-date technical knowledge of legal and regulatory information concerning the given business area • Responsible for resolving any and all pre-bill edits, denials, etc. for assigned accounts