Company: Presbyterian Health Services Corp.
Posted on: January 16, 2020
Type of Opportunity: Full Time
Work Schedule: Days
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 / 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. Responsible
for the handling of all correspondance related to the billing of a
claim for all lines of business, answers questions and updates
accounts as necessary. Responsible for submission of all electronic
claims through PC-based processing system. Submits paper claims to
non-electronic carriers with required documentation. Responsible
for correcting any errors made by other department to ensure
claimes are submitted correctly. Contacts payers to determine
benefit eligibilty and coverage.
* 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
* 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
* 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.
* Must be an effective team member with great communication skills.
Must participate in team meetings and communicate work related
ideas and concerns proactively. Identifies trends and issues and
reports them to the Claims Manager for resolve.
* Must develop positive working relationships with team members and
all PHS departments.
* Ensures that goals and objectives are met in conformity with PHS
policies and procedures with CMS compliance rules and regulations.
* Stays informed of changes in billing procedures that impact
processing of claims and/or reimbursement effectively.
* Effectively operates and is familiar with various computer
systems. These may include the following: Epic, Med Assets,
FISS/DDE, PHP On-Line, Payer portals/on lines systems, Microsoft
Office Suite and internet.
* Reviews and manages individual work queues to ensure key
performance indicators are met.
* Responsible for daily claims interfaces, uploading and monitoring
daily maintenance reports. Corrects errors on final bills before
* Maintain claims WQ and ensure timely follow-up is completed for
each outstanding claim. Refer accounts, in accordance with PHS
guidelines to Claims manager for adjustment. * Works directly with
other departments and insurance companies to get claims processed
and paid. * Identifies and resolve patient billing complaints. *
Maintains strictest confidentially, adheres to all HIPAA guidelines
* Enhances billing department and hospital reputation by accepting
ownership for accomplishing new and different requests, exploring
opportunities to add value to job accomplishments.
* Performs other duties as assigned
*Works bundled episode accounts and adds modifier in Charge Review
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. Continuous
learning is vital due to payer regulations and payer requirements
changing frequently. Excellent problem solving skills to determine
root cause and trends. Basic understanding of provider enrollment
process including NPI and taxonomy codes.
Essential: * High School Diploma or GED
Benefits are effective day-one (for .45 FTE and above) and
- Competitive salaries
- Full medical, dental and vision insurance
- Flexible spending accounts (FSAs)
- Free wellness programs
- Paid time off (PTO)
- Retirement plans, including matching employer
- Continuing education and career development opportunities
- Life insurance and short/long term disability programsAbout
Presbyterian Healthcare Services is 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, it is the state's largest private employer with approximately
Presbyterian's story is really the story of the remarkable people
who have chosen to work here. Starting with Reverend Cooper who
began our journey in 1908, the hard work of thousands of
physicians, employees, board members, and other volunteers brought
Presbyterian from a tiny tuberculosis sanatorium to a statewide
healthcare system, serving more than 700,000 New Mexicans.
We are part of New Mexico's history - and committed to its future.
That is why we will continue to work just as hard and care just as
deeply to serve New Mexico for years to come.
About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American
influences contribute to a culturally rich lifestyle. Add in
Albuquerque's International Balloon Fiesta, Los Alamos' nuclear
scientists, Roswell's visitors from outer space, and Santa Fe's
artists, and you get an eclectic mix of people, places and
experiences that make this state great.
Cities in New Mexico are continually ranked among the nation's best
places to work and live by Forbes magazine, Kiplinger's Personal
Finance, and other corporate and government relocation managers
like Worldwide ERC.
New Mexico offers endless recreational opportunities to explore,
and enjoy an active lifestyle. Venture off the beaten path,
challenge your body in the elements, or open yourself up to the
expansive sky. From hiking, golfing and biking to skiing,
snowboarding and boating, it's all available among our beautiful
wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer
with smoke free campuses.
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Keywords: Presbyterian Health Services Corp., Albuquerque , Billing Specialist, Accounting, Auditing , Albuquerque, New Mexico
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