Patient Billing & Collections Specialist

Presbyterian Healthcare Services; Albuquerque (NM); On-site; USD 23,000 - 37,000; Full time

Job summary

Presbyterian Healthcare Services in Albuquerque, NM seeks a Patient Accounting Collections Specialist to follow up, collect, and resolve outstanding accounts receivable and ensure timely reimbursement for billed charges. The role covers communication with insurers and patients, medical records provision, and daily reconciliation within a team-driven environment.

The position requires strong organization, familiarity with payer regulations, and the ability to operate Epic, FinThrive, and related

Qualifications

• High School diploma or GED required.
• Less than 1-year healthcare clerical or customer service experience preferred.
• Must be passionate about contributing to 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. Must be able to work in a fast-paced environment and contend with continually changing payer regulations and requirements.
• Basic knowledge of ICD-10, HCPCS, CPT codes, Revenue Codes, UB04 and HCFA 1500 claim forms and an understanding of electronic processing of 837 and 835 is preferred.
• Basic knowledge of Coordination of benefits and the Medicare MSPQ preferred.
• Must have basic knowledge of various payer requirements, claim submission processes for major insurances carriers and intermediaries.
• Must have basic knowledge of the revenue cycle processes.
• Must have the ability to provide a high-speed DSL or cable modem for a home office. A minimum standard speed for optimal performance of 25x10 (25mbps download x 10mbps upload) is required.
• Must be able to provide a confidential workspace that is HIPPA compliant and free from distractions.

Responsibilities

• Performs accounts receivable follow-up activities for their assigned work queues and/or miscellaneous A/R reports.
• Responsible for contacting insurance companies, patients, and employers regarding outstanding claims.
• Responsible for providing any information (medical records, itemized statements, etc) requested by insurance companies to process claims.
• Must maintain a system to ensure timely follow up is completed for each outstanding claim.
• Responsible for identifying and reporting insurance payor issues to lead, providing all pertinent information to include examples, correspondence, EOBs, claims, etc.
• Consult with lead regarding next steps with difficult claims.
• Must communicate all issues to teammates and Follow-up & Collection Supervisor.
• Refer accounts, in accordance with PHS guidelines, to leadership for adjustment, agency placement or attorney referral.
• Cross train in the various Patient Accounting Department areas to be completely familiar with all aspects of patient accounting functions as they relate to collections.
• Perform other duties as assigned by the Follow-up & Collection Supervisor and/or Manager.
• Document accounts in accordance with established PHS policies and procedures.
• Effectively operates and is familiar with various computer systems. These may include the following: Epic, FinThrive, FISS/DDE, Presbyterian Health Plan Provider Portal, Payer portals, Microsoft Office Suite.
• Must be an effective team member with great communication skills.
• Must participate in team meetings and communicate work related ideas and concerns proactively.
• Must develop and maintain positive working relationships with team members and all PHS departments.
• Ensures that goals and objectives are met in conformity with PHS policies and procedures and CMS compliance rules and regulations.
• Maintains strictest confidentiality, adheres to all HIPAA guidelines/regulations.

Education

High School diploma or GED

Tools

Epic

FinThrive

FISS/DDE

Presbyterian Health Plan Provider Portal

Payer portals

Microsoft Office Suite

Job description

Presbyterian Healthcare Services in Albuquerque, NM seeks a Patient Accounting Collections Specialist to follow up, collect, and resolve outstanding accounts receivable and ensure timely reimbursement for billed charges. The role covers communication with insurers and patients, medical records provision, and daily reconciliation within a team-driven environment.

The position requires strong organization, familiarity with payer regulations, and the ability to operate Epic, FinThrive, and related