PFS Government A/R Specialist

Now hiring aPFS Government A/R Specialist

Accurately submit all insurance claims for all payer types including Government payers within claims clearinghouse application and patient accounting system. Research analyze and followup on all payer edits/rejections ensuring accurate and timely claim submission in alignment with payers regulations and filing limits. Adheres to compliance and regulatory rules as mandated by CMS state and federal regulations payer contracts and established Presbyterian Healthcare Services (PHS) department policies and procedures. Performs a variety of duties that include the use of payer web portals or calls to insurance companies to resolve billing errors. Review and resolve individual work queues within patient accounting system for clean import into clearinghouse. Responsible for submission of all electronic claims within clearinghouse. Submits paper claims to nonelectronic payers with required documentation if necessary. Responsible for root cause analysis and next step resolution of denials. Performs a variety of duties including A/R followup appeals customer service processing of correspondence and daily reconciliation of activities.

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

• Full Time Exempt: No
• Job is based at Rev Hugh Cooper Admin Center
• Remote work from home: this job is intended to be conducting in the state of New Mexico.
• 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.

• High school degree or GED required shortterm training on insurance collections and claims processing. Minimum one years experience in insurance followup billing and collections.
• Demonstrated ability to communicate effectively via telephone and in writing and be computer literate.
• Must be passionate about contributing to an organization focused on continuously improving patient experiences and the health of our community.
• Experience working in patient accounting billing system or claims clearinghouse such as Epic or nThrive are preferred.
• Proficient with Microsoft Office Suite products required. Excellent organizational problemsolving verbal and written communication skills along with attention to detail and the ability to interact effectively with other functional areas and management teams are required.
• Must have a strong work ethic and demonstrated ability to work effectively in a team environment.
• Must be able to prioritize and manage a highvolume workload.
• Must be able to work in a fastpaced environment and contend with continually changing payer regulations and requirements.
• Proficient knowledge of ICD10 HCPCS CPT codes Revenue Codes UB04 and HCFA 1500 claim forms and an understanding of electronic processing of 837 and 835.
• Proficient knowledge of Coordination of benefits and the Medicare MSPQ.
• Must have proficient knowledge of various payer requirements claim submission processes for major insurances carriers and intermediaries.
• Must have basic knowledge of the revenue cycle processes.
• Must have the ability to provide a highspeed DSL or cable modem for a home office. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Must be able to provide a confidential workspace that is HIPPA compliant and free from distractions.

• Prepares processes and files accurate and timely insurance claims for all payer types in accordance with department policy and payer requirements
• Resolve prebilling edits for compliant and accurate billing.
• Responsible for referring accounts with claim edits back to appropriate departments for additional review to ensure clean claim submission.
• Review and resolves individual work queues timely to ensure key performance indicators are met.
• Responsible for contacting insurance companies patients and/or employer groups to obtain required information for claim submission.
• Ensure timely acceptance of claims file imports.
• Responsible for notifying lead of any invalid claims file imports or delays.
• Notify lead of any billing issues relating to internal PHS departments contracted vendors and/or payers providing all pertinent information to include examples correspondence EOBs claims etc.
• Perform both electronic and paper claim submission/filing for primary and secondary claims including HIPPA compliant attachments medical records correspondence and/or appropriate forms for payers.
• Stays informed of changes in billing procedures that impact processing of claims and/or reimbursement.
• Identifies trends issues or changes to billing procedures that impact processing of claims and/or reimbursement and report them to leadership for resolve.
• Responsible for completing special projects by set deadlines with little to no supervision.
• Performs accounts receivable followup activities for their assigned work queues and/or miscellaneous A/R reports.
• Responsible for contacting insurance companies patients and employers regarding outstanding claims.
• Responsible for providing any information (medical records itemized statements etc) requested by insurance companies to process claims.
• Must communicate all issues to teammates and Supervisor.
• Refer accounts in accordance with PHS guidelines to leadership for adjustment agency placement or attorney referral.
• Cross train in the various Patient Accounting Department areas to be completely familiar with all aspects of patient accounting functions as they relate to collections.
• Must maintain a system to ensure timely follow up is completed for each outstanding claim.
• Document accounts in accordance with established PHS policies and procedures.
• Performs denial followup activities for assigned payors utilizing work queues.
• Submits corrected claims reconsiderations and/or appeals to overturn denials.
• Responsible for providing any information (medical records itemized statements etc.) requested by insurance companies to process claims and overturn denials.
• Must follow process/procedures to ensure timely follow up on outstanding denials.
• Must be able to work with the Supervisor/Manager to pull documentation for audits performed by internal and external partners.
• Effectively operates and is familiar with various computer systems. These may include the following: Epic nThrive FISS/DDE Presbyterian Health Plan Provider Portal Payer portals Microsoft Office Suite.
• Must be an effective team member with great communication skills.
• Must participate in team meetings and communicate work related ideas and concerns proactively.
• Must develop and maintain positive working relationships with team members and all PHS departments.
• Ensures that goals and objectives are met in conformity with PHS policies and procedures and CMS compliance rules and regulations.
• Enhances billing department by identifying and reporting areas of opportunity for process improvement within the workflow to leadership.
• Maintains strictest confidentiality adheres to all HIPAA guidelines/regulations.
• Performs other duties as assigned.

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.