Health Services Assistant

Now hiring a Health Services Assistant

Responsible for supporting Health Services Coordination functions including but not limited to medical records coordination technical retrospective claims review referral/auth. entry research which may include but not limited to claims eligibility benefits provider contracts coordination of benefits provider education data entry report generation act as liaison to and/or assists PHS clinical leaders

How you belong matters here.

We value our employees differences and find strength in the diversity of our team and community.

At Presbyterian its not just what we do that matters. Its how we do it and it starts with our incredible team. From Information Technology to Food Services and beyond our nonclinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Part Time .45 to .89 Exempt: No
• Job is based Presbyterian Hospital
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical wellness program vision dental paid time off retirement and more for FT employees.

Ideal Candidate:

• Associates Degree or completion of a medical vocational program

• High School Diploma GED required. Associates Degree or completion of a medical vocational program preferred.
• One to three years experience in a medical or health insurance position

• Prior Authorization may process emergent/elective and transitional prior authorization requests according to established evidenced based criteria. Screens prior authorization requests not meeting guidelines and requests/gathers/forwards additional information.
• May conduct utilization review by monitoring daily prior authorization requests and documenting timely updates for service requests. Completes Administrative Denials and submits Medical Director Reviews as directed.
• Correspondence with Provider/Member Notifies members and providers including but not limited to approvals provider notification of service requests and out of network approvals
• Coordination of Benefits by monitoring benefit limitations for all members. Identifies members for case management or needed follow up regarding subrogation or coordination of benefits. Refers to appropriate departments as needed. Provides claims follow up as indicated.
• Documents in multiple computer applications timely and according to unit policy and regulations. Documents appropriate codes and claims payment information to ensure accurate claims payment. Data entry to ensure accurate records notifications/referrals. Submits Patient referrals for complaints and compliments.
• Liaison with providers and facilities telephonically include problem solving regarding member needs Requests clinical updates.
• May respond to incoming calls routed through skillbased technology to meet quality standards and performance measurements. May conduct outbound calls as required and meet established quality/quantity guidelines supporting initiatives and/or programs.

All benefitseligible Presbyterian employees receive a comprehensive benefits package that includes medical dental vision shortterm and longterm disability group term life insurance and other optional voluntary benefits.

Wellness
Presbyterians Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your wellbeing. Earn gift cards and more by taking an active role in our personal wellbeing 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 notforprofit healthcare system of nine hospitals a statewide health plan and a growing multispecialty medical group. Founded in New Mexico in 1908 we are the states largest private employer with nearly 14000 employees including more than 1600 providers and nearly 4700 nurses.

Our health plan serves more than 580000 members statewide and offers Medicare Advantage Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drugfree and tobaccofree employer with smoke free campuses.