PFS Government A/R Specialist I-ABQ

Presbyterian is seeking a PFS Government A/R Specialist I!

In this role you will:

• Accurately submit insurance claims for all payer types including Government payers

• Research analyze and resolve payer edits rejections and denials

• Ensure compliance with CMS state/federal regulations and payer contracts

• Manage A/R follow-up appeals and customer service inquiries

• Utilize payer portals and patient accounting systems to resolve billing errors

• Review and process claims for both electronic and paper submissions

• Conduct root cause analysis and support continuous improvement in claims processing

This is an excellent opportunity for candidates with strong attention to detail problem-solving skills and knowledge of medical billing and reimbursement practices.

Were determined to take care of those working in healthcare.

Presbyterian is dedicated to improving peoples lives - the lives of our patients and the lives of our coworkers. Were a locally owned and operated which encourages supportive leadership that empowers employees. And we provide the opportunity to grow from entry-level to the most senior positions.

Why Join Us

• Full Time - Exempt: No
• Job is based at Rev Hugh Cooper Admin Center
• 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: Minimum one years experience in insurance follow-up billing and collections.

• High school degree or GED required short-term training on insurance collections and claims processing. Minimum one years experience in insurance follow-up 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 problem-solving 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 high-volume workload.
• Must be able to work in a fast-paced environment and contend with continually changing payer regulations and requirements.
• Proficient knowledge of ICD-10 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 high-speed 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.

• Prepare process and submit accurate insurance claims for all payer types

• Resolve claim edits billing issues and denials to ensure clean claim submission

• Perform A/R follow-up appeals and reconsiderations in compliance with payer and CMS regulations

• Communicate with insurance companies patients and employers to obtain required information

• Manage and document work queues to meet performance targets

• Provide requested medical records or documentation to support claim processing

• Stay informed of billing and reimbursement procedure changes; identify trends and escalate issues

• Maintain compliance with HIPAA confidentiality and PHS policies

• Collaborate with team members and leadership to support continuous process improvement

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical dental vision short-term and long-term 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 well-being. Earn gift cards and more by taking an active role in our personal well-being 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 ensure the patients members and communities we serve can achieve their best health. We are a 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 states largest private employer with nearly 14000 employees.

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 drug-free and tobacco-free employer with smoke free campuses.