Presbyterian Healthcare Services
Patient Accounting Denials Specialist II-ABQ
Presbyterian Healthcare Services, Albuquerque, New Mexico, United States, 87101
Patient Accounting Denials Specialist II-ABQ
Join to apply for the
Patient Accounting Denials Specialist II-ABQ
role at
Presbyterian Healthcare Services
Location Address:
9521 San Mateo NE, Albuquerque, New Mexico 87113-2237, United States of America
Base Pay Range:
$15.99/hr – $26.35/hr
Summary
Responsible for root cause analysis and next step resolution of denials. Performs a variety of duties, including A/R follow-up, appeals, customer service, processing of correspondence, and daily reconciliation of activities.
Type of Opportunity:
Full time
Job Exempt:
No
Job Is Based:
Reverend Hugh Cooper Administrative Center
Work Shift:
Weekday Schedule Monday-Friday (United States of America)
Responsibilities
Performs denial follow-up activities for assigned payors utilizing work queues.
Submits corrected claims, reconsiderations and/or appeals to overturn denials.
Provides any information (medical records, itemized statements, etc.) requested by insurance companies to process claims and overturn denials.
Follows process/procedures to ensure timely follow‑up on outstanding denials.
Documents accounts in accordance with established PHS policies/procedures.
Is knowledgeable in various computer systems (Electronic Health Record, claims clearinghouse, FISS/DDE, payer portals, Microsoft Office Suite).
Utilizes communication skills to be an effective team member.
Actively participates in team meetings and takes a proactive approach to communicate work‑related ideas and concerns.
Develops and maintains professional work relationships with team members, PHS departments, and outside agencies.
Maintains strict confidentiality, adheres to all HIPAA and CMS compliance rules and regulations.
Performs other duties as assigned by the Denial Supervisor and/or Manager.
Conducts root cause analysis and next‑step resolution of denials.
Reviews incoming denials to identify trends and performs root cause analysis to determine resolution to prevent ongoing denials.
Consults with lead regarding next steps with difficult claims.
Qualifications
High school degree or GED required, short‑term training on insurance collections and claims processing. Minimum three years experience in insurance follow‑up, billing, and collections. Demonstrated ability to communicate effectively via telephone and in writing; computer literacy required. Must be passionate about contributing to an organization focused on continuously improving patient experiences and the health of our community. Experience with Microsoft Office Suite products required. Excellent 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. Basic knowledge of coordination of benefits and Medicare MSPQ preferred. Basic knowledge of payer requirements, claim submission processes for major insurance carriers and intermediaries, and revenue cycle processes. Must prioritize and manage a high‑volume workload in a fast‑paced environment amid continually changing payer regulations and requirements.
Benefits
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.
Wellness
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 screening and more.
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting grower's markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
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 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.
AA/EOE/VET/DISABLED. PHS is a drug‑free and tobacco‑free employer with smoke‑free campuses.
#J-18808-Ljbffr
Patient Accounting Denials Specialist II-ABQ
role at
Presbyterian Healthcare Services
Location Address:
9521 San Mateo NE, Albuquerque, New Mexico 87113-2237, United States of America
Base Pay Range:
$15.99/hr – $26.35/hr
Summary
Responsible for root cause analysis and next step resolution of denials. Performs a variety of duties, including A/R follow-up, appeals, customer service, processing of correspondence, and daily reconciliation of activities.
Type of Opportunity:
Full time
Job Exempt:
No
Job Is Based:
Reverend Hugh Cooper Administrative Center
Work Shift:
Weekday Schedule Monday-Friday (United States of America)
Responsibilities
Performs denial follow-up activities for assigned payors utilizing work queues.
Submits corrected claims, reconsiderations and/or appeals to overturn denials.
Provides any information (medical records, itemized statements, etc.) requested by insurance companies to process claims and overturn denials.
Follows process/procedures to ensure timely follow‑up on outstanding denials.
Documents accounts in accordance with established PHS policies/procedures.
Is knowledgeable in various computer systems (Electronic Health Record, claims clearinghouse, FISS/DDE, payer portals, Microsoft Office Suite).
Utilizes communication skills to be an effective team member.
Actively participates in team meetings and takes a proactive approach to communicate work‑related ideas and concerns.
Develops and maintains professional work relationships with team members, PHS departments, and outside agencies.
Maintains strict confidentiality, adheres to all HIPAA and CMS compliance rules and regulations.
Performs other duties as assigned by the Denial Supervisor and/or Manager.
Conducts root cause analysis and next‑step resolution of denials.
Reviews incoming denials to identify trends and performs root cause analysis to determine resolution to prevent ongoing denials.
Consults with lead regarding next steps with difficult claims.
Qualifications
High school degree or GED required, short‑term training on insurance collections and claims processing. Minimum three years experience in insurance follow‑up, billing, and collections. Demonstrated ability to communicate effectively via telephone and in writing; computer literacy required. Must be passionate about contributing to an organization focused on continuously improving patient experiences and the health of our community. Experience with Microsoft Office Suite products required. Excellent 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. Basic knowledge of coordination of benefits and Medicare MSPQ preferred. Basic knowledge of payer requirements, claim submission processes for major insurance carriers and intermediaries, and revenue cycle processes. Must prioritize and manage a high‑volume workload in a fast‑paced environment amid continually changing payer regulations and requirements.
Benefits
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.
Wellness
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 screening and more.
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting grower's markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
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 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.
AA/EOE/VET/DISABLED. PHS is a drug‑free and tobacco‑free employer with smoke‑free campuses.
#J-18808-Ljbffr