PFS Government A/R Specialist

Responsibilities

• Adequately submit all insurance claims for all payer types, including government payers, within the claims clearinghouse application and patient accounting system.
• Research, analyze, and follow up on all payer edits/rejections to ensure accurate and timely claim submission in alignment with payer’s regulations and filing limits.
• Communicate with insurance companies, patients, and employers to obtain required information.
• Manage and document work queues to meet performance targets.
• Provide requested medical records or documentation to support claim processing.
• Stay informed of billing and reimbursement procedure changes; identify trends and escalate issues.
• Maintain compliance with HIPAA, confidentiality, and PHS policies.
• Collaborate with team members and leadership to support continuous process improvement.

Qualifications

• High school degree or GED required, short-term training on insurance collections and claims processing.
• Minimum one year experience in insurance follow-up, billing, and collections.
• Demonstrated ability to communicate effectively via telephone and in writing and be computer literate.
• 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.
• 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 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.
• Basic knowledge of the revenue cycle processes.
• 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 HIPPA compliant and free from distractions.

Benefits

This evergreen posting supports ongoing and future hiring needs. All benefits-eligible Presbyterian employees receive a 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 is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinars, preventive screenings and more.