Remote Utilization Review Rn Jobs in Santa Fe, NM

Location Address:
Remote OfficeSanta Fe, NM 87501
Compensation Pay Range:
Minimum Offer $21.70Maximum Offer $33.14Now Hiring: Remote IP Facility CCS Coder
Summary:
Codes more than one of the following: inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services for PMG specialty providers for the purpose of reimbursement, research and in compliance with Federal regulation according to diagnosis, operation and procedure using the ICD-9/10 CM and CPT-4 classification system. Ensures adherence to Hospital and Departmental Policies and ProceduresType of Opportunity: Full timeJob Exempt: NoJob is based: Remote Workers New MexicoWork Shift: Varied Days and Hours (United States of America)
Responsibilities:
*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
Qualifications:
High school diploma/GED required.
Must have any one of the following coding certifications at time of hire: HCS-D, CCS, CCS-P, CPC-H or CPC, or RHIT/RHIA with achievement of one of the coding credentials above within one year of hire.
One-three years experience as a coder required.
Must possess computer skills including, but not limited to, Word, Excel, PowerPoint.
Experience with an encoder preferred.
Experience with an Electronic Medical Record preferred.
Must be able to use the internet and other electronic resources for the purpose of research
UPDATED 8/27/25
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.
About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are 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 and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services