Presbyterian Healthcare Services este o organizație nonprofit integrată de servicii medicale, care deservește comunitățile din întregul stat New Mexico. Activitatea sa include spitale, servicii de îngrijire urgentă, cabinete de medicină primară și de specialitate, îngrijire virtuală prin VirtualPRES, servicii medicale la domiciliu și planuri de asigurare de sănătate pentru persoane fizice, membri Medicaid, persoane înscrise în Medicare Advantage și grupuri de angajatori. Organizația oferă îngrijire în domenii precum oncologie, neuroștiințe, transplant, chirurgie, sănătate comportamentală și alte specialități clinice, susținută de servicii pentru pacienți precum MyChart, myPRES și asistență pentru facturare. Activitatea sa include, de asemenea, sprijin financiar, inițiative de sănătate comunitară, programe caritabile și parteneriate asociate educației medicale. Cu o forță de muncă extinsă în domeniul serviciilor medicale și al asigurărilor, Presbyterian Healthcare Services oferă oportunități de carieră în funcții clinice, operaționale, administrative și de asistență.
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.
Descriere
- 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.
Cerințe
- 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.
Beneficii
- 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