Patient Accounting Denials Specialist I

Location: 9521 San Mateo NE, Albuquerque, NM 87113-2237

About the Role

Presbyterian is hiring a skilled Patient Accounting Denials Specialist I for the Business-Office Physician Services team. This role focuses on root cause analysis and resolution of denials, including A/R follow-up, appeals, customer service, correspondence processing, and daily reconciliation of activities.

Responsibilities

• Perform denial follow-up activities for assigned payors using work queues.
• Submit corrected claims, reconsiderations, and/or appeals to overturn denials.
• Provide requested information (e.g., medical records, itemized statements) to insurance companies 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 and procedures.
• Utilize various computer systems, including Electronic Health Record, claims clearinghouse, FISS/DDE, payer portals, and Microsoft Office Suite.
• Communicate effectively as a team member and actively participate in team meetings.
• Develop and maintain professional relationships with team members, PHS departments, and outside agencies.
• Maintain strict confidentiality and adhere to all HIPAA and CMS compliance rules and regulations.

Qualifications

• High school degree or GED required.
• Minimum two years of experience in insurance follow-up, billing, and collections.
• Short-term training in insurance collections and claims processing.
• Demonstrated ability to communicate effectively via telephone and in writing.
• Computer literacy and experience with Microsoft Office Suite preferred.
• Strong organizational, problem-solving, verbal, and written communication skills.
• Attention to detail and ability to interact effectively with other functional areas and management teams.
• Strong work ethic and ability to work effectively in a team environment.
• Ability to prioritize and manage a high-volume workload in a fast-paced environment.
• Ability to adapt to continually changing payer regulations and requirements.

Pay

Pay Range: $16.66 – $26.70 per hour.

Benefits

All benefits-eligible Presbyterian employees receive a comprehensive benefits package, including:

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

Wellness: Presbyterian’s Employee Wellness rewards program offers opportunities to enhance health and activate well-being. Earn gift cards and other rewards by participating in wellness activities such as challenges, webinars, and preventive screenings.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. As a locally owned, not-for-profit healthcare system, we operate 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 over 1,600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide, offering Medicare Advantage, Medicaid (Centennial Care), and Commercial health plans.

We are committed to improving the health of New Mexicans through initiatives like hosting growers’ markets and partnering with local communities.