Third Party Claims Representative
Full Time
Albuquerque, NM 87114
From $15 an hour
Posted
Job description
Overview:
Type of Opportunity: Full Time
FTE: 1.000000
Exempt: No
Work Schedule: Days Qualifications:
Learn more about our employee benefits:
https://www.phs.org/careers/employee-benefits/Pages/default.aspx
Why work at Presbyterian?
Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.
About Presbyterian Healthcare Services
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
About Our Regional Delivery System
We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.
About New Mexico
Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.
New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
Responsible for accurate, timely preparation and submission of claims to third party payers. Adhering to compliance and regulatory rules and regulations including researching and resolving outstanding accounts receivable
Type of Opportunity: Full Time
FTE: 1.000000
Exempt: No
Work Schedule: Days
High School degree or G.E.D is required. 6 months to 1 year experience in medical claims processing and collections. Demonstrated ability to communicate effectively in person, via telephone and in writing. Requires good organizational skills, and the ability to analyze reports and system processes. Demonstrated ability to work effectively in a team environment. Knowledge of ICD9, CPT and HCPCS coding preferred. Computer literate
Education:
Essential:
Responsibilities:
Essential:
- High School Diploma or GED
- Responsible for maintenance and control of unbilled insurance files for a given section of patient accounts. Reviews files daily and corrects errors on final bills for readiness for billing.
- Analyzes, Monitors and Resolves pre-billing compliance and collection reports..
- Reprints and re-bills claims in accordance with payer specific guidelines. Performs secondary billing with attachments. Submits adjustments, appeals and Fair Hearing documentation when necessary.
- Reviews daily and weekly inventory, including ECT levels, and billed claim levels, and identifies and addresses trends.
- Via telephone or Access On-line Systems, verifies payment or denial status of claims. Documents accounts in accordance with established PHS policies and procedures.
- Responsible for identifying and documenting insurance payer issues as they arise. Must communicate all issues to teammates and Non-Government Billing/Follow-up Supervisor. Responsible for maintaining files containing all pertinent information for each account to include, correspondence, EOB s, claims, etc.
- Must be an effective team member with good communication skills. Must participate in team meetings, communicate work related ideas and concerns proactively, and assist in finding appropriate resolutions.
- Cross train in the various Patient Accounting Department areas to be completely familiar with all aspects of Patient Accounting functions as they relate to billing and collection.
- Adhere to all PHS and Patient Accounting Department policies and procedures to promote a smooth working environment and uphold the PHS vision by practicing the CARES behaviors at all times.
- Performs other duties as assigned by the Non-Government Billing/Follow-up Supervisor and/or the 3rd Party Billing Manager.
We offer more than the standard benefits!
Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!
Learn more about our employee benefits:
https://www.phs.org/careers/employee-benefits/Pages/default.aspx
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. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.
Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.
About Presbyterian Healthcare Services
Presbyterian Healthcare Services 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.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
About Our Regional Delivery System
Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.
We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.
About New Mexico
New Mexico continues to grow steadily in population and features a low cost-of living.
Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.
New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Minimum Offer: USD $15.00/Hr. Maximum Offer: USD $21.48/Hr.
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