PFS Government A/R Specialist I

Location: Remote Office, Santa Fe, NM 87501

About the role

Build your career. Make a difference. Presbyterian is hiring a skilled PFS Government A/R Specialist I. This is an excellent opportunity for candidates with strong attention to detail, problem-solving skills, and knowledge of medical billing and reimbursement practices.

Responsibilities

• Accurately submit insurance claims for all payer types, including Government payers
• Research, analyze, and resolve payer edits, rejections, and denials
• Ensure compliance with CMS, state/federal regulations, and payer contracts
• Manage A/R follow-up, appeals, and customer service inquiries
• Utilize payer portals and patient accounting systems to resolve billing errors
• Review and process claims for both electronic and paper submissions
• Conduct root cause analysis and support continuous improvement in claims processing

Qualifications

• High school degree or GED required; short-term training on insurance collections and claims processing.
• Minimum one year of experience in insurance follow-up, billing, and collections.
• Demonstrated ability to communicate effectively via telephone and in writing; computer literate.
• Must be passionate about contributing to an organization focused on continuously improving patient experiences and the health of the community.
• Experience working in patient accounting billing system or claims clearinghouse, such as Epic or Thrive (preferred).
• Proficient with Microsoft Office Suite products required.
• Excellent organizational, problem-solving, verbal and written communication skills; attention to detail; 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 contend with continually changing payer regulations and requirements.
• Proficient knowledge of ICD-10, HCPCS, CPT codes, Revenue Codes, UB04 and HCFA 1500 claim forms; understanding of electronic processing of 837 and 835.
• Proficient knowledge of Coordination of benefits and the Medicare MSPQ.
• Proficient knowledge of various payer requirements and claim submission processes for major insurance carriers and intermediaries.
• Basic knowledge of the revenue cycle processes.
• Ability to provide a high-speed DSL or cable modem for a home office; minimum standard speed of 25 Mbps download × 10 Mbps upload required for optimal performance.
• Ability to provide a confidential workspace that is HIPAA‑compliant and free from distractions.

Benefits

• Medical
• Wellness program
• Vision
• Dental
• Paid time off
• Retirement
• 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 activate well‑being, including