PFS Government A/R Specialist

Presbyterian is seeking a PFS Government A/R Specialist I!

In this role, you will:

Accurately submit insurance claims for all payer types, including Government payers

• Research, analyze, and resolve payer edits, rejections, and denials

• Ensure compliance with CMS, state/federal regulations, and payer contracts

• Manage A/R follow-up, appeals, and customer service inquiries

• Utilize payer portals and patient accounting systems to resolve billing errors

• Review and process claims for both electronic and paper submissions

• Conduct root cause analysis and support continuous improvement in claims processing

This is an excellent opportunity for candidates with strong attention to detail, problem-solving skills, and knowledge of medical billing and reimbursement practices.

• Full Time - Exempt: No
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Ideal Candidate: Minimum one years experience in insurance follow-up, billing, and collections.

• High school degree or GED required, short-term training on insurance collections and claims processing. Minimum one 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 working in patient accounting billing system or claims clearinghouse, such as Epic or nThrive are preferred.
• Proficient 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.
• Must be able to prioritize and manage a high-volume, workload.
• Must be able to work in a fast-paced environment and contend with continually changing payer regulations and requirements.
• Proficient 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.
• Proficient knowledge of Coordination of benefits and the Medicare MSPQ.
• Must have proficient knowledge of various payer requirements, claim submission processes for major insurances carriers and intermediaries.
• Must have basic knowledge of the revenue cycle processes.
• Must have the ability to provide a high-speed DSL or cable modem for a home office. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Must be able to provide a confidential workspace that is HIPPA compliant and free from distractions.

• Prepare, process, and submit accurate insurance claims for all payer types

• Resolve claim edits, billing issues, and denials to ensure clean claim submission

• Perform A/R follow-up, appeals, and reconsiderations in compliance with payer and CMS regulations

• Communicate with insurance companies, patients, and employers to obtain required information

• Manage and document work queues to meet performance targets

• Provide requested medical records or documentation to support claim processing

• Stay informed of billing and reimbursement procedure changes; identify trends and escalate issues

• Maintain compliance with HIPAA, confidentiality, and PHS policies

• Collaborate with team members and leadership to support continuous process improvement

About Presbyterian Healthcare Services

Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.

The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities-like challenges, webinars, and screenings-with opportunities to earn gift cards and other incentives.

As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships.

Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.