PFS Billing Specialist I

Now hiring a PFS Billing Specialist-Patient Accounting

Accurately processes all insurance claims for all payers types including Government payers, Research grants and Occ Medicine. Analyzes, interprets, and resolves all billing edits to ensure claims are filed accurately within the payer's regulations and filing limits. Adheres to compliance and regulatory rules as mandated by CMS, state and federal regulations, payer contracts and established department policies and procedures. Works closely with cash team to resolve unapplied cash, credit balances or other posting issues. Contacts patient/members directly regarding eligiblity errors or to complete MSPQ in order to resolve outstanding billing edits. Research, analysises and follow's up on all payer edits / rejections ensuring accurate and timely claim submission. Peforms a variety of duties that includes the use of payer web pages or calls insurance companys to resolve billing issues. May follow-up on balances due from insurance. Responsible for the handling of all correspondance related to the billing of a claim for all lines of business, answers questions and updates accounts as necessary. Responsible for submission of all electronic claims through PC-based processing system. Submits paper claims to non-electronic carriers with required documentation. Responsible for correcting any errors made by other department to ensure claimes are submitted correctly. Contacts payers to determine benefit eligibilty and coverage.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

Full Time - Exempt: No
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

• Minimum of 1 year experience in medical claim processing and/or insurance billing for hospital, physician or hospice.
• One year experience in a computerized account receivable system required.
• Experience with Microsoft Office Suite products, internet and automated billing systems such as Epic and Medassets is preferred.
• Excellent organizational problem solving, solid verbal and written communication, attention to detail and the ability to interact effectively with other functional areas and management team is 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.
• Detailed 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.
• Detailed knowledge of Coordination of benefits and the Medicare MSPQ required.
• Must have thorough knowledge of various payer requirements, claim submission processes for major insurances carriers and intermediaries and knowledge of the revenue cycle processes in terms of what and how work is processed.
• Continuous learning is vital due to payer regulations and payer requirements changing frequently.
• Excellent problem solving skills to determine root cause and trends. Basic understanding of provider enrollment process including NPI and taxonomy codes

• Responsible for managing the workflow consisting of all unbilled claims. Must bill all claims timely and accurately according to patient accounting departments policies and procedures as well as payer requirements.
• Resolves prebilling edits for compliant and accurate billing to ensure claims are billed correctly.
• Performs both electronic and paper claim processing for primary and secondary claims along with attachments, medical records, mail and appropriate forms for payers following HIPPA requirements.
• Documents accounts in accordance with established PHS policies and procedures.
• Responsible for contacting insurance companies, patients or employer groups regarding unbilled claims needing information to submit claim. * Must work closely with outside agencies contracted with Patient Accounting as well as internal PHS departments and assist with claim related billing issues.
• Must be an effective team member with great communication skills. Must participate in team meetings and communicate work related ideas and concerns proactively. Identifies trends and issues and reports them to the Claims Manager for resolve.
• Must develop positive working relationships with team members and all PHS departments.
• Ensures that goals and objectives are met in conformity with PHS policies and procedures with CMS compliance rules and regulations. * Stays informed of changes in billing procedures that impact processing of claims and/or reimbursement effectively.
• Effectively operates and is familiar with various computer systems. These may include the following: Epic, Med Assets, FISS/DDE, PHP On-Line, Payer portals/on lines systems, Microsoft Office Suite and internet.
• Reviews and manages individual work queues to ensure key performance indicators are met.
• Responsible for daily claims interfaces, uploading and monitoring daily maintenance reports. Corrects errors on final bills before submitted.
• Maintain claims WQ and ensure timely follow-up is completed for each outstanding claim. Refer accounts, in accordance with PHS guidelines to Claims manager for adjustment. * Works directly with other departments and insurance companies to get claims processed and paid. * Identifies and resolve patient billing complaints. * Maintains strictest confidentially, adheres to all HIPAA guidelines / regulations.
• Enhances billing department and hospital reputation by accepting ownership for accomplishing new and different requests, exploring opportunities to add value to job accomplishments.
• Performs other duties as assigned
• Works bundled episode accounts and adds modifier in Charge Review WQs

We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

https://www.phs.org/careers/why-work-with-us/benefits

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. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a 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 1,600 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.

About Our Regional Delivery System

Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.

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.

About New Mexico

New Mexico continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

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