Patient Accounting Denials Specialist I

Location Address:

Compensation Pay Range:

Summary:

Responsibilities:

* Performs denial followup activities for assigned payors utilizing work queues.

* Submits corrected claims, reconsiderations, and/or appeals to overturn denials.

* Provides any information requested by insurance companies (medical records, itemized statements, etc.) to process claims and overturn denials.

* Follows established processes and procedures to ensure timely followup on outstanding denials.

* Documents accounts in accordance with established PHS policies and procedures.

* Demonstrates knowledge of various computer systems (Electronic Health Record, claims clearinghouse, FISS/DDE, payer portals, Microsoft Office Suite).

* Utilizes effective communication skills to function as a productive team member.

* Actively participates in team meetings and takes a proactive approach to sharing workrelated ideas and concerns.

* Develops and maintains professional working relationships with team members, PHS departments, and outside agencies.

* Maintains strict confidentiality and adheres to all HIPAA and CMS compliance rules and regulations.

* Performs other duties as assigned by the Denial Supervisor and/or Manager.

Qualifications:

• High school degree or GED required, short-term training on insurance collections and claims processing. Minimum two 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 being part of an organization focused on continuously improving patient experiences and the health of our community.
• Experience with Microsoft Office Suite products preferred. 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 and be able to work in a fast-paced environment and contend with continually changing payer regulations and requirements.

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, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' 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 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 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.