[Hiring] PFS Government A/R Specialist II @Presbyterian Healthcare Services

Role Description

Build your Career. Make a Difference. Presbyterian is hiring a skilled PFS Government A/R Specialist II. The person in this position will 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 payers 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.

Type of Opportunity: Full time

Job Exempt: No

Job is based: Remote Workers New Mexico

Work Shift: Weekday Schedule Monday-Friday (United States of America)

Responsibilities

• Perform 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.
• Perform A/R follow-up, appeals, customer service, processing of correspondence, and daily reconciliation of activities.
• Prepare, process, and file 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.
• Refer accounts with claim edits back to appropriate departments for additional review to ensure clean claim submission.
• Review and resolve individual work queues timely to ensure key performance indicators are met.
• Contact insurance companies, patients, and/or employer groups to obtain required information for claim submission.
• Ensure timely acceptance of claims file imports.
• Notify 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.
• Stay informed of changes in billing procedures that impact processing of claims and/or reimbursement.
• Identify trends, issues or changes to billing procedures that impact processing of claims and/or reimbursement and report them to leadership for resolve.

Qualifications

• High school degree or GED required, short-term training on insurance collections and claims processing.
• Minimum two 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.

Benefits

• Comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
• Presbyterian's Employee Wellness rewards program designed to provide engaging opportunities to enhance health and activate well-being.
• Earn gift cards and more by participating in wellness activities like wellness challenges, webinars, preventive screenings and more.