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Presbyterian Healthcare Services BILLING SPECIALIST in Albuquerque, New Mexico

Type of Opportunity: Full Time

FTE: 1.000000

Exempt: No

Work Schedule: Weekday Schedule Monday-Friday


Accurately processes all insurance claims for all payers types including Government payers, Research grants and Occ Medicine. Analyzes, interprets, and resolves all billing edits to ensure claims are filed accurately within the payer's regulations and filing limits. Adheres to compliance and regulatory rules as mandated by CMS, state and federal regulations, payer contracts and established department policies and procedures. Works closely with cash team to resolve unapplied cash, credit balances or other posting issues. Contacts patient/members directly regarding eligibility errors or to complete MSPQ in order to resolve outstanding billing edits. Research, analysis and follow's up on all payer edits / rejections ensuring accurate and timely claim submission. Performs a variety of duties that includes the use of payer web pages or calls insurance companies to resolve billing issues. May follow-up on balances due from insurance. Responsible for the handling of all correspondence related to the billing of a claim for all lines of business, answers questions and updates accounts as necessary. Responsible for submission of all electronic claims through PC-based processing system. Submits paper claims to non-electronic carriers with required documentation. Responsible for correcting any errors made by other department to ensure claims are submitted correctly. Contacts payers to determine benefit eligibility and coverage.

  • Responsible for managing the workflow consisting of all unbilled claims. Must bill all claims timely and accurately according to patient accounting departments policies and procedures as well as payer requirements.

  • Resolves prebilling edits for compliant and accurate billing to ensure claims are billed correctly.

  • Performs both electronic and paper claim processing for primary and secondary claims along with attachments, medical records, mail and appropriate forms for payers following HIPPA requirements.

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

  • Responsible for contacting insurance companies, patients or employer groups regarding unbilled claims needing information to submit claim. * Must work closely with outside agencies contracted with Patient Accounting as well as internal PHS departments and assist with claim related billing issues.

  • Must be an effective team member with great communication skills. Must participate in team meetings and communicate work related ideas and concerns proactively. Identifies trends and issues and reports them to the Claims Manager for resolve.

  • Must develop positive working relationships with team members and all PHS departments.

  • Ensures that goals and objectives are met in conformity with PHS policies and procedures with CMS compliance rules and regulations. * Stays informed of changes in billing procedures that impact processing of claims and/or reimbursement effectively.

  • Effectively operates and is familiar with various computer systems. These may include the following: Epic, Med Assets, FISS/DDE, PHP On-Line, Payer portals/on lines systems, Microsoft Office Suite and internet.

  • Reviews and manages individual work queues to ensure key performance indicators are met.

  • Responsible for daily claims interfaces, uploading and monitoring daily maintenance reports. Corrects errors on final bills before submitted.

  • Maintain claims WQ and ensure timely follow-up is completed for each outstanding claim. Refer accounts, in accordance with PHS guidelines to Claims manager for adjustment. * Works directly with other departments and insurance companies to get claims processed and paid. * Identifies and resolve patient billing complaints. * Maintains strictest confidentially, adheres to all HIPAA guidelines / regulations.

  • Enhances billing department and hospital reputation by accepting ownership for accomplishing new and different requests, exploring opportunities to add value to job accomplishments.

  • Performs other duties as assigned

*Works bundled episode accounts and adds modifier in Charge Review WQs

Minimum of 1 year experience in medical claim processing and/or insurance billing for hospital, physician or hospice.

One year experience in a computerized account receivable system required. Experience with Microsoft Office Suite products, internet and automated billing systems such as Epic and Medassets is preferred. Excellent organizational problem solving, solid verbal and written communication, attention to detail and the ability to interact effectively with other functional areas and management team is 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. Detailed knowledge of ICD-10, HCPCS, CPT codes, Revenue Codes, UB04 and HCFA 1500 claim forms and an understanding of electronic processing of 837 and 835 is preferred. Detailed knowledge of Coordination of benefits and the Medicare MSPQ required. Must have thorough knowledge of various payer requirements, claim submission processes for major insurances carriers and intermediaries and knowledge of the revenue cycle processes in terms of what and how work is processed. Continuous learning is vital due to payer regulations and payer requirements changing frequently. Excellent problem solving skills to determine root cause and trends. Basic understanding of provider enrollment process including NPI and taxonomy codes.


Essential: * High School Diploma or GED

Competencies and skills:


  • SKILL-Ability to effectively interact with customers to understand their needs and explain data

  • SKILL-Microsoft Office

  • Planning and coordinating organizational change

  • Anticipating & Addressing Customer Needs

  • Educating Employees, Customers & Transferring Knowledge

  • Functioning as an Effective Contingent Member

  • Diagnosing & Resolving Problems

  • Acquiring & Applying Superior Skills to achieve Quality Outcomes

  • Functioning as an Effective Team Member

  • Organizational Skills

  • SKILL-Prioritize and manage a high volume workload.

  • Demonstration of high degree of independent problem solving and critical thinking skills.

  • SKILL-Demonstrate ability to work effectively in a team environment

  • SKILL-Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff using strong dialogue and customer service competencies.

  • SKILL-Written communication

Benefits are effective day-one (for .45 FTE and above) and include:

  • Competitive salaries

  • Full medical, dental and vision insurance

  • Flexible spending accounts (FSAs)

  • Free wellness programs

  • Paid time off (PTO)

  • Retirement plans, including matching employer contributions

  • Continuing education and career development opportunities

  • Life insurance and short/long term disability programs

About Us

Presbyterian Healthcare Services is 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, it is the state's largest private employer with approximately 11,000 employees.

Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.

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's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.

Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.

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.

Requisition ID: 2021-21141

Street: 9521 San Mateo NE