Remote Claims Denials & Appeals Specialist

Presbyterian Healthcare Services; Santa Fe (NM); Remote; USD 23,000 - 37,000; Full time

Job summary

Presbyterian Healthcare Services is hiring a skilled Patient Accounting Denials Specialist I. The role focuses on root-cause analysis and resolving denials, including A/R follow-up, appeals, and daily reconciliation.

This is a full-time remote position based in New Mexico with daytime shifts. The incumbent will submit corrected claims, provide information to insurers, and ensure timely follow up on denials, leveraging EHRs, payer portals, and standard office software.

Qualifications

• Demonstrated ability to communicate effectively via telephone and in writing.
• Must be passionate about improving patient experiences and community health.
• Strong work ethic and ability to work in a team environment.
• Able to prioritize and manage high-volume workload in a fast-paced setting.

Responsibilities

• Performs denial follow-up activities for assigned payors using work queues.
• Submits corrected claims, reconsiderations, and/or appeals to overturn denials.
• Provides requested information (medical records, itemized statements, etc.) to insurance companies to process claims.
• Ensures timely follow up on outstanding denials by following established procedures.
• Documents accounts per Presbyterian Health Services policies/procedures.
• Familiar with EHR, claims clearinghouse, FISS/DDE, payer portals, and Microsoft Office Suite.
• Communicates effectively with team members and participates in meetings.

Skills

Communication skills (phone & writing)

Computer literacy

Teamwork and collaboration

Education

High school diploma or GED

Tools

Electronic Health Record (EHR) systems

claims clearinghouse

FISS/DDE

Payer portals

Microsoft Office Suite

Job description

Presbyterian Healthcare Services is hiring a skilled Patient Accounting Denials Specialist I. The role focuses on root-cause analysis and resolving denials, including A/R follow-up, appeals, and daily reconciliation.

This is a full-time remote position based in New Mexico with daytime shifts. The incumbent will submit corrected claims, provide information to insurers, and ensure timely follow up on denials, leveraging EHRs, payer portals, and standard office software.