RN - Nurse Auditor - HCC Program Management
 Presbyterian Healthcare Services | |
 United States, New Mexico, Albuquerque | |
| 1100 Central Avenue Southeast (Show on map) | |
 Mar 10, 2026 | |
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Location Address: 9521 San Mateo NE Albuquerque, NM 87113-2237Compensation Pay Range: Minimum Offer $67,100.80 Maximum Offer $102,460.80Summary: Presbyterian is seeking a Hybrid Remote RN-Nurse Auditor for the HCC Program Management Department. This role will support the Hierarchical Condition Categories (HCC) processes for PMG and AHWA Clinics. This is a remote position that requires clinical knowledge and coding experience. The position will require the candidate to become certified in Risk Adjustment Coding within one year of hire. Performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered to Medicare Managed Care Product members is complete, compliant, and accurate to support optimal Medicare reimbursement. Validates and interprets medical documentation to ensure capture of all relevant coding based on CMS HCC conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives. Identifies members with high-risk CMS HCCs and refers cases for annual follow-up care by disease management, case management, and primary care providers as appropriate for assessment/intervention. Our team embraces the mission and values of PHS, open communication, value, and respect among coworkers. If you are accountable, dependable, and able to work collaboratively and autonomously in a team environment and you are committed to the patients and PHS we encourage you to apply now.How you grow, learn and thrive matters here. Responsibilities: Type of Opportunity: Full Time Location: Cooper Center/Admin Building located in Albuquerque NM. Candidates must be local, in Albuquerque Metro area and must be located within 60 miles of this location : 9521 San Mateo Blvd NE Abq, NM 87113
Qualifications:
We're all about well-being, starting with yours. 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. | |