PFS Government A/R Specialist

About the role

Build your Career. Make a Difference. Presbyterian is hiring a skilled PFS Government A/R Specialist. This position will accurately submit all insurance claims, for all payer types, including Government payers within claims clearinghouse application and patient accounting system. Research, analyze and follow-up on all payer edits/rejections, ensuring accurate and timely claim submission in alignment with payer's regulations and filing limits. Type of Opportunity: Full time Job Exempt: No Job is based: Reverend Hugh Cooper Administrative Center Work Shift: Days (United States of America)

Responsibilities

• This position will adhere 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.
• 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 supp ort continuous process improvement

Requirements

• 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 Thrive 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.
• 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
• 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
• Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) a

Benefits

Additional Information

Location Address: 9521 San Mateo NE Albuquerque, NM 87113-2237 Compensation Pay Range: Minimum Offer $16.66 Maximum Offer $24.19 Now Hiring: PFS Government A/R Specialist

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