PFS Government A​/R Specialist

Location Address: 9521 San Mateo NE Albuquerque, NM

Compensation Pay Range:
Minimum Offer $16.66 Maximum Offer $26.70

Now Hiring: PFS Government A/R Specialist

I

Summary:

Accurately submit all insurance claims, for all payer types, including Government payers within claims clearinghouse application and patient accounting system. Research, analyze and follow-up on all payer edits/rejections, ensuring accurate and timely claim submission in alignment with payer's regulations and filing limits. Adheres to compliance and regulatory rules as mandated by CMS, state and federal regulations, payer contracts and established Presbyterian Healthcare Services (PHS) department policies and procedures.

Performs a variety of duties that include the use of payer web portals or calls to insurance companies to resolve billing errors. Review and resolve individual work queues within patient accounting system for clean import into clearinghouse. Responsible for submission of all electronic claims within clearinghouse. Submits paper claims to non-electronic payers with required documentation if necessary. 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:

Days (United States of America)

• Prepares, processes, and files accurate and timely insurance claims for all payer types in accordance with department policy and payer requirements
• Resolve prebilling edits for compliant and accurate billing.
• Responsible for referring accounts with claim edits back to appropriate departments for additional review to ensure clean claim submission.
• Review and resolves individual work queues timely to ensure key performance indicators are met.
• Responsible for contacting insurance companies, patients, and/or employer groups to obtain required information for claim submission.
• Ensure timely acceptance of claims file imports.
• Responsible for notifying lead of any invalid claims file imports or delays.
• Notify lead of any billing issues relating to internal PHS departments, contracted vendors, and/or payers, providing all pertinent information to include examples, correspondence, EOBs, claims, etc.
• Perform both electronic and paper claim submission/filing for primary and secondary claims, including HIPPA compliant attachments, medical records, correspondence and or appropriate forms for payers.
• Stays informed of changes in billing procedures that impact processing of claims and or reimbursement.
• Identifies trends, issues or changes to billing procedures that impact processing of claims and or reimbursement and report them to leadership for resolve.
• Responsible for completing special projects by set deadlines, with little to no supervision.
• Performs accounts receivable follow-up activities for their assigned work queues and/or miscellaneous A/R reports.
• Responsible for contacting insurance companies, patients, and employers regarding outstanding claims.
• Responsible for providing any information (medical records, itemized statements, etc) requested by insurance companies to process claims.
• Must communicate all issues to teammates and Supervisor.
• Refer accounts, in accordance with PHS guidelines, to leadership for adjustment, agency placement or attorney referral.
• Cross train in the various Patient Accounting Department areas to be completely familiar with all aspects of patient accounting functions as they relate to collections.
• Must maintain a system to ensure timely follow up is completed for each outstanding claim.
• Document accounts in accordance with established PHS policies and procedures.
• Performs denial follow-up activities for assigned payors utilizing work queues.
• Submits corrected claims, reconsiderations and or appeals to overturn denials.
• Responsible for providing any information (medical records, itemized statements, etc.) requested by insurance companies to process claims and overturn denials.
• Must follow process/procedures to ensure timely follow up on outstanding denials.
• Must be able to work with the Supervisor/Manager to pull documentation for audits performed by internal and external partners.
• Effectively operates and is familiar with various computer systems. These may include the following:
  Epic, nThrive, FISS/DDE, Presbyterian Health Plan Provider Portal, Payer portals,…