PFS Government A/R Specialist I

0090 Presbyterian System Services; Santa Fe (NM); Hybrid; USD 23,000 - 37,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement plan

Job summary

Presbyterian Healthcare Services seeks a PFS Government A/R Specialist I for our remote New Mexico team. This role focuses on accurate government claim submissions and diligent AR follow-up to optimize reimbursement.

Ideal candidates have at least one year in insurance follow-up and billing, strong communication skills, and familiarity with Epic or Thrive systems. The position is full-time with standard days.

Qualifications

• High school degree or GED required.
• Minimum one year experience in insurance follow-up, billing, and collections.
• Demonstrated ability to communicate effectively via telephone and in writing and be computer literate.
• Experience with patient accounting billing system or claims clearinghouse (e.g., Epic or Thrive) preferred.

Responsibilities

• Submit insurance claims for all payer types, including government payers.
• Research and resolve payer edits, rejections, and denials.
• Ensure CMS and payer contract compliance.
• Manage A/R follow-up, appeals, and customer service inquiries.
• Use payer portals and patient accounting systems to resolve billing errors.
• Review and process claims for electronic and paper submissions.
• Conduct root cause analysis to improve claims processing.

Skills

Attention to detail

Problem solving

Verbal communication

Written communication

Teamwork

Education

High school diploma or GED

Tools

Epic

Thrive

Payer portals

Microsoft Office

HCFA 1500/837 processing

Job description

Location Address: Remote Office Santa Fe, NM 87501

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

Now Hiring: PFS Government A/R Specialist I

Summary: Build your Career. Make a Difference. Presbyterian is hiring a skilled PFS Government A/R Specialist I. This is an excellent opportunity for candidates with strong attention to detail, problem-solving skills, and knowledge of medical billing and reimbursement practices.

Type of Opportunity: Full time

Job Exempt: No

Job is based: Remote Workers New Mexico

Work Shift: Days (United States of America)

Responsibilities

• Accurately submit insurance claims for all payer types, including Government payers
• Research, analyze, and resolve payer edits, rejections, and denials
• Ensure compliance with CMS, state/federal regulations, and payer contracts
• Manage A/R follow-up, appeals, and customer service inquiries
• Utilize payer portals and patient accounting systems to resolve billing errors
• Review and process claims for both electronic and paper submissions
• Conduct root cause analysis and support continuous improvement in claims processing

This is an excellent opportunity for candidates with strong attention to detail, problem-solving skills, and knowledge of medical billing and reimbursement practices.

Full Time - Exempt: No Job is based at Rev Hugh Cooper Admin Center Work hours: Days

Benefits

• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
• 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.

Qualifications

• High school degree or GED required, short-term training on insurance collections and claims processing.
• Minimum one 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 contributing to an organization focused on continuously improving patient experiences and the health of our community.
• Experience working in patient accounting billing system or claims clearinghouse, such as Epic or Thrive are preferred.
• Proficient 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.
• Proficient 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.
• Proficient knowledge of Coordination of benefits and the Medicare MSPQ.
• Must have proficient 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 a confidential workspace that is HIPPA compliant and free from distractions.

Company Culture

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 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.

From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. As an organization, we are committed to improving the health of our communities.

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. 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.