Patient Financial Services Billing Specialist

phsorg; United States; On-site; USD 22,000 - 36,000; Full time

Job summary

Presbyterian Healthcare Services is hiring a Patient Financial Services Billing Specialist to submit insurance claims across multiple payer types and to resolve edits promptly. The role requires attention to detail, strong communication, and teamwork within a fast-paced environment.

The position supports Medicare/Medicaid and commercial payers, using Epic, nThrive, and payer portals. A high school diploma or GED and basic office skills are essential, with preference for prior clerical experience.

Qualifications

• High School Diploma or GED required.
• Less than 1-year clerical or customer service experience preferred.
• Experience with Microsoft Office Suite products required.
• Excellent organizational, problem-solving, verbal and written communication skills.
• Must be able to prioritize and manage a high-volume workload.
• Ability to adapt to a fast-paced environment with changing payer regulations.

Responsibilities

• Submit all insurance claims for all payer types in the clearinghouse and patient accounting system.
• Resolve edits/rejections to ensure accurate and timely claim submission.
• Comply with CMS/state/federal regulations and payer contracts.
• Communicate with insurance companies, patients, and employer groups to obtain required information.
• Operate Epic, nThrive, FISS/DDE and portals for claim submission.

Skills

Attention to detail

Communication

Teamwork

Problem solving

Education

High School Diploma or GED

Tools

Epic

nThrive

FISS/DDE

Presbyterian Health Plan Portal

Payer portals

Microsoft Office Suite

Job description

Now Hiring: Patient Financial Services Billing Specialist

Build your Career. Make a Difference. Presbyterian is hiring a skilled PFS Billing Specialist

Location Address:

9521 San Mateo NEAlbuquerque, NM 87113-2237

Compensation Pay Range:

Minimum Offer $16.66Maximum Offer $26.70

Type of Opportunity:

Full time

Job Exempt:

No

Job is based:

Reverend Hugh Cooper Administrative Center

Work Shift:

Days (United States of America)

Responsibilities:

Accurately submit all insurance claims, for all payer types, including Government payers within claims clearinghouse application and patient accounting system. Resolve edits/rejections, ensuring accurate and timely claim submission in alignment with payer's regulations and filing limits. Adheres to compliance and regulatory rules as mandated by CMS, state and federal regulations, payer contracts and established Presbyterian Healthcare Services (PHS) department policies and procedures. Performs a variety of duties that include the use of payer web portals or calls to insurance companies to resolve billing errors. Review and resolve individual work queues within patient accounting system for clean import into clearinghouse. Responsible for submission of all electronic claims within clearinghouse. Submits paper claims to non-electronic payers with required documentation if necessary.

Some key responsibilities include:

• Prepares, processes, and files accurate and timely insurance claims for all payer types in accordance with department policy and payer requirements
• Resolve prebilling edits for compliant and accurate billing.
• Responsible for referring accounts with claim edits back to appropriate departments for additional review to ensure clean claim submission.
• Review and resolves individual work queues timely to ensure key performance indicators are met.
• Document accounts in accordance with established PHS policies and procedures.
• Responsible for contacting insurance companies, patients, and/or employer groups to obtain required information for claim submission.
• Notify leadership of any billing issues relating to internal PHS departments or contracted vendors.
• Perform both electronic and paper claim submission/filing for primary and secondary claims, including HIPPA compliant attachments, medical records, correspondence and/or appropriate forms for payers.
• Stays informed of changes in billing procedures that impact processing of claims and/or reimbursement.
• Effectively operates and is familiar with various computer systems. These may include the following: Epic, nThrive, 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.
• Performs other duties as assigned.

Qualifications:

• High School Diploma or GED required.
• Less than 1-year 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 required.
• 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 (25mpbs download x 10mpbs upload) is required.
• Must have the ability to provide a confidential work space that is HIPPA compliant and free from distractions.

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 p