Patient Accounting Denials Specialist II-ABQ

Presbyterian Healthcare Services

58d • $16 - $24

About The Position

Summary: 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.

Requirements

• High school degree or GED required, short-term training on insurance collections and claims processing.
• Minimum three years experience in insurance follow-up, billing, and collections.
• Demonstrated ability to communicate effectively via telephone and in writing and be computer literate.
• Must be passionate about contributing to an organization focused on continuously improving patient experiences and the health of our community.
• Experience with Microsoft Office Suite products required.
• Excellent organizational, problem-solving, verbal, and written communication skills, along with, attention to detail and the ability to interact effectively with other functional areas and management teams are required.
• Must have a strong work ethic and demonstrated ability to work effectively in a team environment.
• Basic knowledge of Coordination of benefits and the Medicare MSPQ preferred.
• Must have basic knowledge of various payer requirements, claim submission processes for major insurances carriers and intermediaries.
• Must have basic knowledge of the revenue cycle processes.
• Must be able to prioritize and manage a high-volume workload and be able to work in a fast-paced environment and contend with continually changing payer regulations and requirements.

Nice To Haves

• Basic knowledge of Coordination of benefits and the Medicare MSPQ preferred.

Responsibilities

• 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.
• Document accounts in accordance with established PHS policies/procedures.
• Knowledgeable in various computer systems (i.e. Electronic Health Record, claims clearinghouse, FISS/DDE, Payer portals, Microsoft Office Suite.)
• Must utilize communication skills to be an effective team member.
• Must actively participate in team meetings and take a proactive approach to communicate work related ideas and concerns.
• Must develop and maintain professional work relationships with team members, PHS departments and outside agencies.
• Maintains strictest confidentiality, adheres to all HIPAA and CMS compliance rules and regulations.
• Perform other duties as assigned by the Denial Supervisor and/or Manager.
• Responsible for root cause analysis and next step resolution of denials.
• Performs denial follow-up activities for assigned payors utilizing work queues and various reports.
• Reviews incoming denials to identify trends and perform root cause analysis to determine resolution to be implemented to prevent ongoing denials
• Consult with lead regarding next steps with difficult claims

Benefits

• All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
• Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees