Patient Financial Services Billing Specialist

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

Pay Range: $16.66 – $26.70

About the role

Presbyterian is hiring a skilled Patient Financial Services (PFS) Billing Specialist. This is a full-time, non-exempt position based at the Reverend Hugh Cooper Administrative Center with a day-shift schedule.

Responsibilities

• Accurately submit all insurance claims, for all payer types (including Government payers), within the claims clearinghouse application and patient accounting system.
• Resolve edits and rejections to ensure accurate and timely claim submission in alignment with payer regulations and filing limits.
• Adhere to compliance and regulatory rules mandated by CMS, state and federal regulations, payer contracts, and established Presbyterian Healthcare Services (PHS) department policies and procedures.
• Perform a variety of duties using payer web portals or calls to insurance companies to resolve billing errors.
• Review and resolve individual work queues within the patient accounting system for clean import into the clearinghouse.
• Submit all electronic claims within the clearinghouse and paper claims to non-electronic payers with required documentation when necessary.
• 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 meet key performance indicators.
• Document accounts in accordance with established PHS policies and procedures.
• Contact 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.
• Stay informed of changes in billing procedures that impact processing of claims and/or reimbursement.
• Effectively operate and be familiar with various computer systems, including Epic, nThrive, FISS/DDE, Presbyterian Health Plan Provider Portal, payer portals, and Microsoft Office Suite.
• Act as an effective team member with strong communication skills.
• Participate in team meetings and proactively communicate work-related ideas and concerns.
• Develop and maintain positive working relationships with team members and all PHS departments.
• Ensure goals and objectives are met in conformity with PHS policies and procedures and CMS compliance rules and regulations.
• Maintain strict confidentiality and adhere to all HIPAA guidelines and regulations.
• Perform other duties as assigned.

Qualifications

• High School Diploma or GED required.
• Less than 1 year of clerical or customer service experience preferred.
• Passion for contributing to an organization focused on continuously improving patient experiences and community health.
• Experience with Microsoft Office Suite products required.
• Excellent organizational, problem-solving, verbal, and written communication skills, with strong attention to detail and the ability to interact effectively with other functional areas and management teams.
• Strong work ethic and demonstrated ability to work effectively in a team environment.
• Ability to prioritize and manage a high-volume workload.
• Ability to work in a fast-paced environment and adapt to 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 transactions preferred.
• Basic knowledge of Coordination of Benefits and the Medicare MSPQ preferred.
• Basic knowledge of various payer requirements, claim submission processes for major insurance carriers, and intermediaries.
• Basic knowledge of revenue cycle processes.
• Ability to provide a high-speed DSL or cable modem for a home office with a minimum standard speed of 25x10 (25 Mbps download x 10 Mbps upload).
• Ability to provide a confidential, HIPAA-compliant workspace free from distractions.

Benefits

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

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

Wellness

Presbyterian's Employee Wellness rewards program is designed to provide engaging opportunities to enhance health and activate well-being. Earn gift cards and more 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. We are a locally owned, not-for-profit healthcare system consisting 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, offering Medicare Advantage, Medicaid (Centennial Care), and Commercial health plans.