Patient Accounting Denials Specialist

About the role

Presbyterian is hiring a skilled Patient Accounting Denials Specialist I to perform root cause analysis and resolution of denials, including A/R follow-up, appeals, customer service, correspondence processing, and daily reconciliation of activities.

Responsibilities

• Perform root cause analysis and next-step resolution of denials
• Perform denial follow-up activities for assigned payors utilizing work queues
• Submit corrected claims, reconsiderations, and/or appeals to overturn denials
• Provide information requested by insurance companies (medical records, itemized statements, etc.) to process claims and overturn denials
• Follow processes/procedures to ensure timely follow-up on outstanding denials
• Document accounts in accordance with established PHS policies/procedures
• Utilize various computer systems (Electronic Health Record, claims clearinghouse, FISS/DDE, payer portals, Microsoft Office Suite)
• Communicate effectively as a team member
• Actively participate in team meetings and proactively communicate work-related ideas and concerns
• Develop and maintain professional work relationships with team members, PHS departments, and outside agencies

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
• Computer literacy
• Passion for improving patient experiences and community health
• Strong work ethic and demonstrated ability to work effectively in a team environment
• Ability to prioritize and manage a high-volume workload in a fast-paced environment
• Ability to contend with continually changing payer regulations and requirements

Benefits

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes:

• Medical, dental, and vision coverage
• Short-term and long-term disability
• Group term life insurance
• Optional voluntary benefits

Presbyterian's Employee Wellness rewards program provides engaging opportunities to enhance health and well-being, including wellness challenges, webinars, preventive screenings, and the ability to earn gift cards for participation.

Pay

Hourly pay range: $16.66 – $26.70

Schedule

• Full-time
• Non-exempt
• Day shift

Location

Reverend Hugh Cooper Administrative Center, 9521 San Mateo NE, Albuquerque, NM 87113

About Presbyterian Healthcare Services

Presbyterian 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. Presbyterian is committed to improving the health of New Mexicans through initiatives such as hosting growers' markets and partnering with local communities.