Medical Claims Analyst/Specialist

Now hiring Remote-Medical Claims Analyst/Specialist

 

Responsible for processing hospital and medical claims and researching pended claims according to established business goals for quality and timliness of claims processing.

 

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 Remote: Open to remote applicants in the United States, except for the following states: Wyoming, North Dakota, and Ohio
• 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:  High School education (G. E. D.), One year office/business experience, experience in medical claims processing

• Claims Analyst - High School education (G. E. D.) required. One year office/business experience, or is currently in a position demonstrating customer service skills. Data entry experience and typing speed of 45 words per minutes preferred
• Claims Specialist - High School plus specialized, short-term training in claims processing. Minimum three years experience in medical claims processing. Demonstrated ability to communicate effectively in person, via telephone and in writing

• Processes hospital and medical claims as according to departmental quality and production standards.
• Pends claims as directed by departmental policies and procedures, follows up for resolution, and processes pended claims immediately following a benefit/payment determination.
• Uses online policies and procedures to ensure accurate and consistent processing of claims.
• Performs tasks individually and as part of an assigned team.

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 $20.57/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.