Overview:
Now hiring an Ambulance Revenue Cycle Specialist II
Responsible for accurate coding of claims according to PHS, local, state, and federal regulations; ensures correct demographic and insurance information in order to safeguard timely and accurate reimbursement for all billed charges; Appeals highly complex claims. Follows-up, collects, and resolves outstanding accounts receivable; Performs a variety of duties including accounts receivable follow-up, customer service, correspondence response, and daily reconciliation of activities. Analyzes and Validates accuracy of accounts with credit balances to determine whether payments and allowances posted are accurate according to contractual agreements and determines if a refund, adjustment, or appeal is required to resolve/close the account; Adheres to compliance and regulatory rules and regulations as mandated by CMS including researching and resolving outstanding or unbilled claims. Communicates information received from the Fiscal Intermediary, Carrier, and all other insurers regarding policies and procedures as they apply to coding, claims billing, and adjudication. As an expert in the ambulance revenue cycle field, actively participates in the training and education of peers and those outside the department.
How you belong matters here.
We value our employees' differences and find strength in the diversity of our team and community.
At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.
Why Join Us
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Full Time - Exempt: No
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Job is based Rev Hugh Cooper Admin Center
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Work hours: Days
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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:
A minimum of two (2) years experience in admissions, medical claims processing, insurance billing, claims follow-up, or collections preferred. EMS licensenure/experience in lieu of admission, medical claims processing, insurance billing, claims follow-up, or collections experience.
Qualifications:
- High School education (G.E.D.) with a minimum of two (2) years experience in admissions, medical claims processing, insurance billing, claims follow-up, or collections preferred.
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EMS licensenure/experience in lieu of admission, medical claims processing, insurance billing, claims follow-up, or collections experience.
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National Academy of Ambulance Coding Certified Ambulance Coder certification preferred (Certification must be obtained within six (6) months of hire.)
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Short-term training in business office process and procedures preferred.
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PC experience with Microsoft Office Word and Excel.
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Excellent organizational, problem solving, verbal, written communication, and ability to interact with other functional areas required.
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Demonstrated ability to work effectively in a team environment. Must be able to prioritize and manage a high volume workload.
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Knowledge of ICD9/ICD10 and HCPCS.
Education Essential: High School Diploma or GED
Responsibilities:
- Responsible for contacting insurance companies, patients, and employers regarding outstanding ambulance claims. Responsible for providing any information (medical records, itemized statements, etc.) requested by insurance companies to process claims. Must maintain a system to ensure timely follow-up is completed for each outstanding claim.
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Maintain workflow consisting of outstanding accounts assigned. Must work and document each account according to Patient Accounting Department policies and procedures. Responsible for following-up on all accounts listed in the workflow until resolved.
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Refer accounts, in accordance with PHS guidelines to ARC Supervisor for write-off, agency, or attorney referral. Refer difficult claims to ARC Supervisor or Manager for advice and/or assistance.
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Must work closely with all outside agencies contracted with the Patient Accounting Department, as well as internal PHS Departments, and assist them with account resolution for any accounts assigned to them by ARC Supervisor or Manager.
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Cross train and job shadow in various Ambulance Revenue Cycle Department areas to be completely familiar with all aspects of ambulance revenue cycle as they relate to ambulance account follow-up and collections.
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Performs accounts receivable credit balance reimbursement analysis to determine if reimbursement, allowances, and patient payments received are correct. Must make appropriate adjustments and refer any refunds to the Cash Processing team. Documents accounts in accordance with established PHS policies and procedures.
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Manages workflow consisting of accounts assigned, and external correspondence, relating to overpayments (or incorrect payments) made by insurance payors or patients within established timeframes.
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Responsible for contacting insurance companies, patients, employers, etc. to resolve any over payment issues that require their assistance.
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Must develop positive working relationship and work closely with all outside agencies contracted with Presbyterian, as well as all third party payers to effectively communicate and resolve overpayment, or incorrect payment, issues.
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Must work closely with all ARC areas and teams regarding discrepancies in charges, payments, allowances, etc. posted to accounts.
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Cross train and job shadow in various Ambulance Revenue Cycle Department areas to be completely familiar with all aspects of ambulance revenue cycle as they relate to account reconciliation and refunds.
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Responsible for identifying and documenting insurance payor issues as they arise. Must communicate all issue to teammates and ARC Supervisor. Responsible for updating public Payor Issue Log and maintaining a file containing all pertinent information for each issue to include correspondence, EOBs, claims, etc.
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Must be an effective team member with good communication skills. Must participate in team meetings, communicate work related ideas and concerns proactively, and assist in finding appropriate resolutions.
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Adhere to all PHS, Patient Accounting Department, and Ambulance Revenue Cycle Department policies, processes, and procedures to promote a smooth working environment, and uphold the PHS vision by practicing the CARES behaviors at all times.
Performs other duties assigned by the ARC Supervisor or Manager.
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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.
Wellness
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.
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are 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, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
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Maximum Offer for this position is up to: USD $23.07/Hr. Compensation Disclaimer: The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.