PFS Billing Specialist

Now Hirirng PFS Billing Specialist 

 

Accurately processes all insurance claims for all payers types including Government payers, Research grants and Occ Medicine. Analyzes, interprets, and resolves all billing edits to ensure claims are filed accurately within the payer's regulations and filing limits. Adheres to compliance and regulatory rules as mandated by CMS, state and federal regulations, payer contracts and established department policies and procedures. Works closely with cash team to resolve unapplied cash, credit balances or other posting issues. Contacts patient/members directly regarding eligiblity errors or to complete MSPQ in order to resolve outstanding billing edits. Research, analysises and follow's up on all payer edits and rejections ensuring accurate and timely claim submission. Peforms a variety of duties that includes the use of payer web pages or calls insurance companys to resolve billing issues. May follow-up on balances due from insurance.

 

How you belong matters here.

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

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: No
• Job is based 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.

• Minimum of 1 year experience in medical claim processing and/or insurance billing for hospital, physician or hospice.
• One year experience in a computerized account receivable system required. Experience with Microsoft Office Suite products, internet and automated billing systems such as Epic and Medassets is preferred.
• Excellent organizational problem solving, solid verbal and written communication, attention to detail and the ability to interact effectively with other functional areas and management team is 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.
• Detailed 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 is preferred.
• Detailed knowledge of Coordination of benefits and the Medicare MSPQ required.
• Must have thorough knowledge of various payer requirements, claim submission processes for major insurances carriers and intermediaries and knowledge of the revenue cycle processes in terms of what and how work is processed.

Education:
Essential:
* High School Diploma or GED

• Responsible for managing the workflow consisting of all unbilled claims.
• Must bill all claims timely and accurately according to patient accounting departments policies and procedures as well as payer requirements.
• Resolves prebilling edits for compliant and accurate billing to ensure claims are billed correctly.
• Performs both electronic and paper claim processing for primary and secondary claims along with attachments, medical records, mail and appropriate forms for payers following HIPPA requirements.
• Documents accounts in accordance with established PHS policies and procedures.
• Responsible for contacting insurance companies, patients or employer groups regarding unbilled claims needing information to submit claim.
• Must work closely with outside agencies contracted with Patient.
• Accounting as well as internal PHS departments and assist with claim related billing issues.
  
  

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
Presbyterian's 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 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.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

USD $21.48/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.