Location Address:

Compensation Pay Range:

Summary:

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 be able 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 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