Posting Details
Interviews are anticipated to be conducted within two weeks of closing date.
This job posting may be used to fill multiple vacancies.
Our Vision
Every New Mexican has access to affordable health care coverage through a coordinated and seamless health care system.
Our Mission
We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.
Our Goals
Leverage purchasing power and partnerships to create innovative policies and models of comprehensive health care coverage that improve the health and well-being of New Mexicans and the workforce.
Achieve health equity by addressing poverty, discrimination, and lack of resources, building a New Mexico where everyone thrives.
Implement innovative technology and data-driven decision-making to provide unparalleled, convenient access to services and information.
Build the best team in state government by supporting employees continuous growth and wellness.
Why does the job exist?
The Senior Healthcare Program Coordinator will:
Contribute to the Medicaid fair hearing appeals process for the State of New Mexico;
Support Medicaid recipients, providers, Managed Care Organizations (MCOs), Third Party Assessor (TPA), Office of Fair Hearings and internal Medical Assistance Division (MAD) staff throughout the fair hearing process;
Review, process, and manage Fair Hearing documentation, including Acknowledgments of Hearing Requests, Summaries of Evidence, Fair Hearing Notices, Continuation of Benefits requests, and other recipient and provider-related appeal materials;
Represent Medical Assistance Division (MAD) during Fair Hearings and related proceedings;
Collaborate and coordinate with Health Care Authority (HCA) program staff, the HCA Office of Fair Hearings, MCOs, MAD Director¿s Office and bureaus, and the HCA Office of General Counsel to ensure effective case management and compliance throughout the fair hearing process.
How does it get done?
The Senior Healthcare Program Coordinator is responsible for:
Collaborating and communicating effectively with internal staff and external stakeholders in a timely and professional manner regarding fair hearing activities and processes;
Conducting research, gathering relevant information, and resolving issues related to fair hearing cases;
Serving as a subject matter expert and providing technical guidance and support to staff and management on fair hearing policies, procedures, and processes;
Compiling, organizing, and monitoring project activities and case progress, ensuring timely follow-up and submission of all required documentation;
Serving as a backup support for the hearing decision letter process to ensure continuity and timely completion of responsibilities;
Tracking, maintaining, and analyzing data related to fair hearing activities, case status, and outcomes;
Maintaining and updating procedural documents to ensure current information, policies, and processes are accurately reflected;
Identifying opportunities to streamline workflows, improve efficiency, and implement process enhancements within the fair hearing program;
Developing and delivering division-wide training programs to educate staff on Fair Hearing processes, procedures, and best practices.
Who are the customers?
Internal and External Stakeholders throughout Healthcare Authority and all New Mexicans on Medicaid.
Ideal Candidate
Internal and External Stakeholders throughout Healthcare Authority and all New Mexicans on Medicaid.
Minimum Qualification
Associate degree in Business Administration, Healthcare Administration, Statistics, Finance, or a related field and two (2) years of experience with a public assistance program, medical, healthcare, educational, or state facility working with policies and procedures, conducting analysis/research, providing or requesting information from the general public, working with communities, working on health or social service related matters, social work/case management, behavioral health, and/or health care. Any combination of education from an accredited college or university in a related field and/or direct experience in this occupation totaling four (4) years may substitute for the required education and experience.
Employment Requirements
Must possess and maintain a valid driver's license.
Must obtain a Defensive driving certification.
Working Conditions
Work is performed in an office setting with exposure to Visual/Video Display Terminal (VDT), extensive personal computer and phone usage with extended periods of sitting.
Supplemental Information
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Agency Contact Information: Jolene Jaffa, (505) 690-9920. Email
For information on Statutory Requirements for this position, click the Classification Description link on the job advertisement.
Bargaining Unit Position
This position is covered by a collective bargaining agreement and all terms/conditions of that agreement apply and must be adhered to.
