Claims - Patient Accounting Denials Specialist

Presbyterian Healthcare Services; Santa Fe (NM); Remote; USD 23,000 - 37,000; Full time

Job summary

Presbyterian Healthcare Services is hiring a skilled Patient Accounting Denials Specialist I. The role focuses on root-cause analysis and resolving denials, including A/R follow-up, appeals, and daily reconciliation.

This is a full-time remote position based in New Mexico with daytime shifts. The incumbent will submit corrected claims, provide information to insurers, and ensure timely follow up on denials, leveraging EHRs, payer portals, and standard office software.

Qualifications

• Demonstrated ability to communicate effectively via telephone and in writing.
• Must be passionate about improving patient experiences and community health.
• Strong work ethic and ability to work in a team environment.
• Able to prioritize and manage high-volume workload in a fast-paced setting.

Responsibilities

• 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, etc.) to insurance companies to process claims.
• Ensures timely follow up on outstanding denials by following established procedures.
• Documents accounts per Presbyterian Health Services policies/procedures.
• Familiar with EHR, claims clearinghouse, FISS/DDE, payer portals, and Microsoft Office Suite.
• Communicates effectively with team members and participates in meetings.

Skills

Communication skills (phone & writing)

Computer literacy

Teamwork and collaboration

Education

High school diploma or GED

Tools

Electronic Health Record (EHR) systems

claims clearinghouse

FISS/DDE

Payer portals

Microsoft Office Suite

Job description

Location Address:

Remote Office Santa Fe, NM 87501

Compensation Pay Range:

Minimum Offer $16.66 Maximum Offer $26.70

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.

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.

We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services