Patient Accounting Denials Specialist

0090 Presbyterian System Services; United States; On-site; USD 23,000 - 37,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Disability insurance

Life insurance

Wellness rewards program

Job summary

Presbyterian Healthcare Services in Albuquerque, NM is hiring a Patient Accounting Denials Specialist I. The role handles denial analysis, A/R follow-up, and appeals to overturn denials.

You’ll work in a full-time daytime schedule at Reverend Hugh Cooper Administrative Center, using EHR and payer portals to support accurate claim processing. Required are a high school diploma or GED with insurance-claims training and at least two years in insurance follow-up, billing, and collections.

Qualifications

• High school diploma or GED required with short-term training in insurance collections/claims processing.
• Minimum two years’ experience in insurance follow-up, billing, and collections.
• Excellent communication skills via telephone and written form; strong computer literacy.
• Goal-driven, team player with passion for improving patient experiences and health outcomes.
• Ability to prioritize in a fast-paced environment amid changing payer regulations.

Responsibilities

• Root cause analysis and next-step resolution of denials.
• Accounts receivable follow-up, appeals, and daily reconciliation of activities.
• Denial follow-up for assigned payors using work queues.
• Submit corrected claims, reconsiderations, and/or appeals to overturn denials.
• Provide information (medical records, itemized statements) as needed by insurers.
• Follow procedures to ensure timely follow-up on denials.
• Document accounts per Presbyterian policies and procedures.
• Use EHR, claims clearinghouse, payer portals, and MS Office proficiently.
• Communicate effectively within the team and attend meetings actively.
• Develop professional relationships with team members and external agencies.

Skills

Insurance follow-up

Billing

Collections

Communication skills

Computer literacy

Education

High school diploma or GED

Short-term training on insurance collections

Tools

Electronic Health Records

Claims clearinghouse

FISS/DDE

Payer portals

Microsoft Office

Job description

Location Address: 9521 San Mateo NE Albuquerque, NM 87113-2237

Compensation Pay Range: Minimum Offer $16.66 Maximum Offer $26.70

Now Hiring: Patient Accounting Denials Specialist

Summary: Build your Career. Make a Difference. Presbyterian is hiring a skilled Patient Accounting Denials Specialist I.

Type of Opportunity: Full time

Job Exempt: No

Job is based: Reverend Hugh Cooper Administrative Center

Work Shift: Days (United States of America)

Responsibilities

• 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.
• 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 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.