PFS Government A/R Specialist

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Summary:

Type of Opportunity:

Job Exempt:

Job is based :

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Responsibilities:

This position will adhere 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.

• Prepare, process, and submit accurate insurance claims for all payer types

• Resolve claim edits, billing issues, and denials to ensure clean claim submission

• Perform A/R follow-up, appeals, and reconsiderations in compliance with payer and CMS regulations

• Communicate with insurance companies, patients, and employers to obtain required information

• Manage and document work queues to meet performance targets

• Provide requested medical records or documentation to support claim processing

• Stay informed of billing and reimbursement procedure changes; identify trends and escalate issues

• Maintain compliance with HIPAA, confidentiality, and PHS policies

• Collaborate with team members and leadership to support continuous process improvement

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 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.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in ourPromise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.