[Hiring] Patient Financial Services Billing Specialist @Presbyterian Healthcare Services

Role Description

Build your Career. Make a Difference. Presbyterian is hiring a skilled PFS Billing Specialist.

• Type of Opportunity: Full time
• Job Exempt: No
• Job is based: Reverend Hugh Cooper Administrative Center
• Work Shift: Days (United States of America)

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 HIPAA 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 including 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 insurance 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 (25mbps download x 10mbps upload) is required.
• Must be able to provide a confidential workspace that is HIPAA 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.