Presbyterian Healthcare Services
PFS Government A/R Specialist
Presbyterian Healthcare Services, Albuquerque, New Mexico, United States, 87101
PFS Government A/R Specialist
Requisition ID
2025-49093
Category
Patient Financial Services
Location : Name
Rev Hugh Cooper Admin Center
Location : City
Albuquerque
Location : State/Province
NM
Minimum Offer
USD $15.87/Hr.
Maximum Offer for this position is up to
USD $23.04/Hr.
Overview
Presbyterian is seeking a
PFS Government A/R Specialist I! In this role, you will: 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
This is an excellent opportunity for candidates with strong attention to detail, problem-solving skills, and knowledge of
medical billing
and
reimbursement practices . Full Time - Exempt: No Job is based at Rev Hugh Cooper Admin Center Work hours: Days Ideal Candidate: The preferred candidate will have practical experience or specialized training in direct patient care, showcasing strong clinical skills and a dedication to empathetic support. Qualifications
High school degree or GED required, short-term training on
insurance collections and claims processing.
Minimum one years experience in insurance
follow-up, billing, and collections. Demonstrated ability to communicate effectively via telephone and in writing and be computer literate. Must be 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 nThrive 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. Must have a strong work ethic and demonstrated ability to work effectively in a team environment. Must be able to prioritize and manage a high-volume, workload. Must be able 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. Must have proficient knowledge of various payer requirements, claim submission processes for major insurances carriers and intermediaries. Must have basic knowledge of the revenue cycle processes. Must have the ability to provide a high-speed DSL or cable modem for a home office. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Must be able to provide a confidential workspace that is HIPPA compliant and free from distractions. Responsibilities
Prepare, process, and submit accurate
insurance claims
for all payer types
Resolve claim edits, billing issues, and denials to ensure clean claim submission
Perform
A/R follow-up, appeals, and reconsiderations
in compliance with payer and CMS regulations
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 supp ort continuous process improvement
Benefits
About Presbyterian Healthcare Services Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits. The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities-like challenges, webinars, and screenings-with opportunities to earn gift cards and other incentives. As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships. Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. Maximum Offer for this position is up to
USD $23.04/Hr.
Compensation Disclaimer
The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.
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Requisition ID
2025-49093
Category
Patient Financial Services
Location : Name
Rev Hugh Cooper Admin Center
Location : City
Albuquerque
Location : State/Province
NM
Minimum Offer
USD $15.87/Hr.
Maximum Offer for this position is up to
USD $23.04/Hr.
Overview
Presbyterian is seeking a
PFS Government A/R Specialist I! In this role, you will: 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
This is an excellent opportunity for candidates with strong attention to detail, problem-solving skills, and knowledge of
medical billing
and
reimbursement practices . Full Time - Exempt: No Job is based at Rev Hugh Cooper Admin Center Work hours: Days Ideal Candidate: The preferred candidate will have practical experience or specialized training in direct patient care, showcasing strong clinical skills and a dedication to empathetic support. Qualifications
High school degree or GED required, short-term training on
insurance collections and claims processing.
Minimum one years experience in insurance
follow-up, billing, and collections. Demonstrated ability to communicate effectively via telephone and in writing and be computer literate. Must be 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 nThrive 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. Must have a strong work ethic and demonstrated ability to work effectively in a team environment. Must be able to prioritize and manage a high-volume, workload. Must be able 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. Must have proficient knowledge of various payer requirements, claim submission processes for major insurances carriers and intermediaries. Must have basic knowledge of the revenue cycle processes. Must have the ability to provide a high-speed DSL or cable modem for a home office. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Must be able to provide a confidential workspace that is HIPPA compliant and free from distractions. Responsibilities
Prepare, process, and submit accurate
insurance claims
for all payer types
Resolve claim edits, billing issues, and denials to ensure clean claim submission
Perform
A/R follow-up, appeals, and reconsiderations
in compliance with payer and CMS regulations
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 supp ort continuous process improvement
Benefits
About Presbyterian Healthcare Services Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits. The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities-like challenges, webinars, and screenings-with opportunities to earn gift cards and other incentives. As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships. Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. Maximum Offer for this position is up to
USD $23.04/Hr.
Compensation Disclaimer
The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.
Need help finding the right job?
We can recommend jobs specifically for you! Click here to get started.