PFS Government A/R Specialist I

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

Job summary

Presbyterian Healthcare Services is hiring a Government A/R Specialist I in Albuquerque, NM. The role focuses on accurate submission of insurance claims for all payer types, including government payers, using payer portals and clearinghouse workflows.

You will analyze denials, perform A/R follow-up, and ensure compliance with CMS and payer rules. Ideal candidates have at least one year of insurance follow-up experience, strong communication skills, and proficiency with Epic, nThrive, and related

Qualifications

• High school diploma or GED required.
• Short-term training on insurance collections and claims processing.
• Minimum one year experience in insurance follow-up, billing, and collections.
• Strong communication via telephone and in writing; computer literate.
• Able to work in a fast-paced environment and maintain accuracy.

Responsibilities

• Prepare, process, and file accurate insurance claims for all payer types.
• Resolve prebilling edits for compliant and accurate billing.
• Refer accounts with claim edits for additional review to ensure clean submission.
• Review and resolve work queues timely to meet KPIs.
• Contact insurance companies, patients, and employer groups for required information.

Education

High school diploma or GED

Tools

Epic

nThrive

FISS/DDE

Presbyterian Health Plan Provider Portal

Payer portals

Microsoft Office Suite

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:

PFS Government A/R Specialist I

Summary:

Accurately submit all insurance claims, for all payer types, including Government payers within claims clearinghouse application and patient accounting system. Research, analyze and follow-up on all payer 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. 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 time Job Exempt: No Job is based: Reverend Hugh Cooper Administrative Center Work Shift: Days (United States of America)

Responsibilities:

• 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.
• Responsible for contacting insurance companies, patients, and/or employer groups to obtain required information for claim submission.
• Ensure timely acceptance of claims file imports.
• Responsible for notifying lead of any invalid claims file imports or delays.
• Notify lead of any billing issues relating to internal PHS departments, contracted vendors, and/or payers, providing all pertinent information to include examples, correspondence, EOBs, claims, etc.
• 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.
• Identifies trends, issues or changes to billing procedures that impact processing of claims and/or reimbursement and report them to leadership for resolve.
• Responsible for completing special projects by set deadlines, with little to no supervision.
• 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 communicate all issues to teammates and 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.
• Must maintain a system to ensure timely follow up is completed for each outstanding claim.
• Document accounts in accordance with established PHS policies and procedures.
• 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.
• Must be able to work with the Supervisor/Manager to pull documentation for audits performed by internal and external partners.
• 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.
• Enhances billing department by identifying and reporting areas of opportunity for process improvement within the workflow to leadership.
• Maintains strictest confidentiality, adheres to all HIPAA guidelines/regulations.
• Performs other duties as assigned.

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 nThrive 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 be able to provide a confidential workspace 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 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.

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