PFS Billing Specialist I
 Presbyterian Healthcare Services | |
life insurance
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 United States, New Mexico, Santa Fe | |
 Mar 03, 2026 | |
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Location Address: Remote Office Santa Fe, NM 87501Compensation Pay Range: Minimum Offer $15.87 Maximum Offer $23.04 Now Hiring: PFS Billing Specialist ISummary: Accurately submit all insurance claims, for all payer types, including Government payers within claims clearinghouse application and patient accounting system. Resolve edits/rejections, ensuring accurate and timely claim submission in alignment with payer's regulations and filing limits. Adheres to compliance and regulatory rules as mandated by CMS, state and federal regulations, payer contracts and established Presbyterian Healthcare Services (PHS) department policies and procedures. Performs a variety of duties that include the use of payer web portals or calls to insurance companies to resolve billing errors. Review and resolve individual work queues within patient accounting system for clean import into clearinghouse. Responsible for submission of all electronic claims within clearinghouse. Submits paper claims to non-electronic payers with required documentation if necessary. Type of Opportunity: Full time Job Exempt: No Job is based: Remote Workers New Mexico Work Shift: Weekday Schedule Monday-Friday (United States of America)Responsibilities: * Prepares, processes, and files accurate and timely insurance claims for all payer types in accordance with department policy and payer requirements* Resolve prebilling edits for compliant and accurate billing. * Responsible for referring accounts with claim edits back to appropriate departments for additional review to ensure clean claim submission. * Review and resolves individual work queues timely to ensure key performance indicators are met. * Document accounts in accordance with established PHS policies and procedures. * Responsible for contacting insurance companies, patients, and/or employer groups to obtain required information for claim submission. * Notify leadership of any billing issues relating to internal PHS departments or contracted vendors. * Perform both electronic and paper claim submission/filing for primary and secondary claims, including HIPPA compliant attachments, medical records, correspondence and/or appropriate forms for payers. * Stays informed of changes in billing procedures that impact processing of claims and/or reimbursement. * Effectively operates and is familiar with various computer systems. These may include the following: Epic, nThrive, FISS/DDE, Presbyterian Health Plan Provider Portal, Payer portals, Microsoft Office Suite. * Must be an effective team member with great communication skills. * Must participate in team meetings and communicate work related ideas and concerns proactively. * Must develop and maintain positive working relationships with team members and all PHS departments. * Ensures that goals and objectives are met in conformity with PHS policies and procedures and CMS compliance rules and regulations. * Maintains strictest confidentiality, adheres to all HIPAA guidelines/regulations. * Performs other duties as assigned. Qualifications: High School Diploma or GED required.Less than 1-year clerical or customer service experience preferred. 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. 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. Basic 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. 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 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 work space that is HIPPA compliant and free from distractions. 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. Wellness Why work at Presbyterian? About Presbyterian Healthcare Services Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services | |