Patient Accounting Denials Specialist I

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

Benefits offered by this job

Wellness program

Comprehensive benefits

Job summary

Presbyterian Healthcare Services is hiring a Patient Accounting Denials Specialist I to perform denial follow-up and appeals in the Business-Office Physician Services. You will support A/R processes, gather records, and maintain compliance with HIPAA and CMS regulations.

The role emphasizes teamwork, detailed documentation, and effective communication across payors and departments, with a full-time day shift at Reverend Hugh Cooper Administrative Center.

Qualifications

• Two years of experience in insurance follow-up, billing, and collections.
• Strong communication via telephone and in writing; computer literate.
• Experience with Microsoft Office Suite preferred; detail-oriented and organized.
• Ability to prioritize; work well in a team and maintain confidentiality.

Responsibilities

• Perform denial follow-up for assigned payors using work queues.
• Submit corrected claims, reconsiderations, and/or appeals to overturn denials.
• Provide requested records (medical notes, itemized statements) to process claims.
• Follow procedures to ensure timely follow-up on denials.
• Document accounts per Presbyterian Health policies and procedures.
• Utilize EHR, clearinghouse, payer portals, and Microsoft Office tools.
• Communicate effectively within the team and participate in meetings.
• Develop professional relationships with team, departments, and outside agencies.
• Maintain confidentiality per HIPAA and CMS rules.

Skills

Communication

Teamwork

Microsoft Office

HIPAA compliance

Education

High school diploma or GED

Tools

Electronic Health Record (EHR)

Payer portals

FISS/DDE

Claims clearinghouse

Job description

Location Address:

9521 San Mateo NEAlbuquerque, NM 87113-2237

Compensation Pay Range:

Minimum Offer $16.66Maximum Offer $26.70Now Hiring: Patient Accounting Denials Specialist I

Summary:

Build your Career. Make a Difference.

Presbyterian is hiring a skilled Patient Accounting Denials Specialist I- Business-Office Physician Services.

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: Reverend Hugh Cooper Administrative CenterWork Shift: Days (United States of America)

Responsibilities:

As a Patient Accounting Denials Specialist I, you will perform 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.

• Maintains strictest confidentiality, adheres to all HIPAA and CMS compliance rules and regulations.

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.

• Experience with Microsoft Office Suite products preferred. Excellent organizational, problem-solving, verbal, and written communication skills, along with, attention to detail and the ability to interact effectively with other functional areas and management teams are 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 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