Claims System Liaison

Now hiring a Claims System Liaison

Work independently with all claims areas to provide technical claims analysis, responsible for resolving complex claims problems, fielding general questions, and direction and assistance to Configuration and IS departments; Functions as claims liaison between claims areas and other functional areas within PHP.

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.

• High School Diploma required and two to three years college level courses/Associates Degree/Diploma or Bachelors Degree in business administration or related field preferred.
• At least 3 years experience in health insurance claims processing and/or related operational areas within a health insurance managed care environment demonstrating a strong knowledge of claims processing

• Serve as liaison between Claims Operations and other functional areas of business.
• Under supervision, submit claims issues/problems by Service Request across functional areas of business (System Configuration, IS, Provider Network Management, Marketing, Clinical Operations, etc.).Analyze policies and procedures to determine changes needed and develop written changes.
• Shares knowledge and information about issues and solutions across business areas.
• Participates in testing of new system configuration to ensure accuracy of Operations policies and procedures and training materials.
• Assists with ensuring policies and procedures are in compliance with CMS, DOI, and NCQA and HEDIS requirements.
• Perform claims adjustments and claims processing as necessary and other functions as required.
• Obtain approval across product and functional lines of business to ensure consistency in our business practices.
• Acts as the claims resource person to answer questions internally or externally for all functional areas of business with minimal assistance
• Participate in benefit contract review to ensure consistency between the benefit contracts and Operations activities.
• Obtain accurate pricing for claims when necessary.
• Perform other duties and functions as required.

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 $26.46/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.