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Remote Patient Financial Services Billing Specialist – New Mexico
Process electronic and paper insurance claims for Presbyterian Healthcare Services’ New Mexico healthcare system. Resolve billing edits and payer issues in a remote role.
विवरण
- Submit accurate insurance claims for all payer types, including government programs, through the claims clearinghouse and patient accounting system.
- Resolve claim edits and rejections according to payer regulations and filing deadlines.
- Follow CMS requirements, state and federal regulations, payer contracts, and Presbyterian Healthcare Services policies and procedures.
- Use payer portals and contact insurers to investigate and correct billing errors.
- Manage assigned work queues to support clean clearinghouse imports and performance targets.
- Transmit electronic claims through the claims clearinghouse.
- Prepare and send paper claims to non-electronic payers with the required documentation.
- Prepare, process, and file accurate primary and secondary claims within required timelines.
- Route accounts with claim edits to the appropriate departments for further review.
- Record account activity in accordance with established policies and procedures.
- Contact insurers, patients, and employer groups to obtain information needed for claim submission.
- Escalate billing issues involving internal departments or contracted vendors to leadership.
- Submit HIPAA-compliant attachments, medical records, correspondence, and payer forms.
- Keep current with billing procedure changes that affect claim processing and reimbursement.
- Use Epic, nThrive, FISS/DDE, the Presbyterian Health Plan Provider Portal, payer portals, and Microsoft Office Suite.
- Attend team meetings and share work-related ideas and concerns.
- Foster constructive working relationships with team members and Presbyterian Healthcare Services departments.
- Carry out goals and objectives in compliance with Presbyterian Healthcare Services policies and CMS requirements.
- Protect confidential information and comply with HIPAA guidelines and regulations.
- Perform additional duties as assigned.
आवश्यकताएँ
- High school diploma or GED is required.
- Less than one year of clerical or customer service experience is preferred.
- Microsoft Office Suite experience is required.
- Demonstrated organizational, problem-solving, verbal communication, and written communication skills.
- Strong attention to detail and the ability to work effectively with other functional areas and management teams.
- Dependable work ethic and the ability to collaborate effectively in a team setting.
- Ability to prioritize tasks and manage a high-volume workload.
- Ability to work in a fast-paced environment with changing payer regulations and requirements.
- Basic knowledge of ICD-10, HCPCS, CPT, and Revenue Codes, as well as UB-04 and HCFA 1500 claim forms, is preferred.
- Basic understanding of electronic 837 and 835 transaction processing is preferred.
- Basic knowledge of coordination of benefits and Medicare MSPQ is preferred.
- Basic understanding of payer requirements and claim submission procedures for major insurers and intermediaries.
- Basic knowledge of revenue cycle operations.
- Ability to provide high-speed DSL or cable modem service for a home office.
- Internet service with minimum speeds of 25 Mbps download and 10 Mbps upload.
- Ability to maintain a private, HIPAA-compliant, distraction-free workspace.
लाभ
- Medical insurance
- Dental insurance
- Vision insurance
- Short-term disability coverage
- Long-term disability coverage
- Group term life insurance
- Optional voluntary benefits
- Employee Wellness rewards program
- Wellness participation gift cards
- Remote or virtual work arrangement
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