Health Services Coordinator: Prior Auth & Claims

Presbyterian Healthcare Services; Albuquerque (NM); On-site; USD 24,000 - 40,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Retirement plan

Paid time off

Job summary

Presbyterian Healthcare Services in Albuquerque, NM seeks a Health Services Assistant to support health services coordination, medical records, claims data, and referrals. This full-time role collaborates with clinical leaders, processes denials, and assists with COB and provider communications.

The ideal candidate has a High School Diploma or GED and 1–3 years in medical or health insurance settings; an Associate degree or vocational training is preferred, with a comprehensive benefits package.

Qualifications

• High School Diploma or GED required.
• Associate degree or completion of medical vocational program preferred.

Responsibilities

• Process prior authorization requests according to established criteria and gather/additional information as needed.
• May conduct utilization review and document updates for service requests.
• Notify members and providers about approvals, referrals, and other communications.
• Monitor coordination of benefits and refer to subrogation or follow-up as needed.
• Document codes and claims payment information to ensure accurate billing.
• Consult with providers and facilities to resolve member needs and coordinate clinical updates.
• Handle calls and outreach to meet quality standards and program goals.

Education

High School Diploma or GED

Associate degree or medical vocational program

Job description

Presbyterian Healthcare Services in Albuquerque, NM seeks a Health Services Assistant to support health services coordination, medical records, claims data, and referrals. This full-time role collaborates with clinical leaders, processes denials, and assists with COB and provider communications.

The ideal candidate has a High School Diploma or GED and 1–3 years in medical or health insurance settings; an Associate degree or vocational training is preferred, with a comprehensive benefits package.