Claims - Patient Accounting Denials Specialist

Presbyterian Healthcare Services; New Mexico; Ibrido; USD 23.000 - 37.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical insurance

Dental insurance

Vision insurance

Disability insurance

Life insurance

Voluntary benefits

Descrizione del lavoro

Presbyterian Healthcare Services is hiring a Patient Accounting Denials Specialist I to analyze root causes of denials and drive next-step resolutions. Responsibilities include A/R follow-up, submitting appeals, securing necessary documentation, and daily reconciliation of activities.

The role is full-time with remote work in New Mexico, requiring efficient communication, strong teamwork, and adherence to payer regulations. Join a mission-driven health system serving New Mexico communities.

Competenze

• High school diploma or GED required, basic insurance collections training.
• Minimum two years experience in insurance follow-up, billing, and collections.
• Demonstrated ability to communicate effectively via telephone and in writing; computer literate.
• Must be passionate about improving patient experiences and community health.
• Strong work ethic and ability to work in a team environment.
• Able to prioritize, manage high-volume workload, and adapt to payer regulations.

Mansioni

• Performs denial follow-up activities for assigned payors using work queues.
• Submits corrected claims, reconsiderations and/or appeals to overturn denials.
• Provides requested information (medical records, itemized statements) to insurers to process claims.
• Follows procedures to ensure timely follow-up on outstanding denials.
• Documents accounts per Presbyterian Healthcare Services policies/procedures.
• Utilizes EHR, claims clearinghouse, FISS/DDE, payer portals, and MS Office Suite.
• Maintains professional relationships with team members and external agencies.
• Participates in team meetings and communicates work-related ideas and concerns.

Conoscenze

Communication

Customer service

Teamwork

Formazione

High school diploma or GED

Strumenti

EHR systems

Claims clearinghouse

FISS/DDE

Payer portals

Microsoft Office

Descrizione del lavoro

Location

Location Address: Remote Office Santa Fe, NM 87501

Compensation

Pay Range: Minimum Offer $16.66 Maximum Offer $26.70

Position

Now Hiring: Claims - Patient Accounting Denials Specialist

Summary

Build your Career. Make a Difference. Presbyterian is hiring a skilled Patient Accounting Denials Specialist I. Responsible for root cause analysis and next step resolution of denials. Performs a variety of duties, including A/R follow-up, appeals, customer service, processing of correspondence, and daily reconciliation of activities.

Type of Opportunity: Full time; Job Exempt: No; Job is based: Remote Workers New Mexico; Work Shift: Days (United States of America).

Responsibilities

• Performs denial follow-up activities for assigned payors utilizing work queues.
• Submits corrected claims, reconsiderations and/or appeals to overturn denials.
• Responsible for providing any information (medical records, itemized statements, etc.) requested by insurance companies to process claims and overturn denials.
• Must follow process/procedures to ensure timely follow up on outstanding denials.
• Document accounts in accordance with established PHS policies/procedures.
• Knowledgeable in various computer systems (i.e. Electronic Health Record, claims clearinghouse, FISS/DDE, Payer portals, Microsoft Office Suite).
• Must utilize communication skills to be an effective team member.
• Must actively participate in team meetings and take a proactive approach to communicate work related ideas and concerns.
• Must develop and maintain professional work relationships with team members, PHS departments and outside agencies.

Qualifications

• High school degree or GED required, short-term training on insurance collections and claims processing.
• Minimum two 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 being part of an organization focused on continuously improving patient experiences and the health of our community.
• 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 and be able to work in a fast-paced environment and contend with continually changing payer regulations and requirements.

Benefits

• 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.

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.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services Here, we’re committed to a different way to make a difference. 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, nurses, employees, board members, and volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than one in three 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.