Claims - Patient Accounting Denials Specialist

Presbyterian Healthcare Services; Santa Fe (NM); À distance; USD 23 000 - 37 000; Plein temps

Avantages offerts par ce poste

Wellness program

Comprehensive benefits

Résumé du poste

Presbyterian Healthcare Services is seeking a Patient Accounting Denials Specialist I for remote work in New Mexico. You will analyze denials, perform claims follow-up, and submit appeals to overturn denials while coordinating with payors and internal teams.

The role emphasizes timely follow-up, documentation, and proficiency with EHR, claims clearinghouses, and payer portals. Strong communication and teamwork are essential in a fast-paced environment.

Qualifications

• High school diploma or GED with insurance collections training.
• Minimum two years experience in insurance follow-up, billing, and collections.
• Strong communication and computer literacy; able to work in fast-paced environment.

Responsabilités

• Performs denial follow-up activities for assigned payors utilizing work queues.
• Submits corrected claims, reconsiderations and/or appeals to overturn denials.
• Provide information requested by insurance companies to process claims and overturn denials.
• Follow processes to ensure timely follow up on denials.
• Document accounts per Presbyterian Health Services policies/procedures.
• Knowledgeable in EHR, claims clearinghouse, FISS/DDE, Payer portals, MS Office.
• Communicate effectively and participate in team meetings; develop professional relationships.

Connaissances

Denial follow-up

Communication

Teamwork

Attention to detail

Time management

Formation

High school diploma or GED

Outils

Electronic Health Record

claims clearinghouse

FISS/DDE

Payer portals

Microsoft Office Suite

Description du poste

Location Address:

Remote OfficeSanta Fe, NM 87501

Compensation Pay Range:

Minimum Offer $16.66Maximum Offer $26.70Now 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 timeJob Exempt: NoJob is based: Remote Workers New MexicoWork 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.

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.

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