PFS Billing Specialist
Location Address:
Remote Office Santa Fe, NM 87501Compensation Pay Range:
Minimum Offer $15.87 Maximum Offer $23.04 Now Hiring: PFS Billing SpecialistSummary:
Presbyterian is seeking a detail driven Claims Submission Specialist responsible for accurately submitting insurance claims across all payer types, including government programs, through the clearinghouse and patient accounting systems. This role ensures timely, compliant claim submission by resolving edits and rejections, adhering to payer regulations and filing limits, and following all CMS, state, federal, and PHS policies. Responsibilities include reviewing and clearing work queues, submitting electronic claims, preparing paper claims for non electronic payers, and using payer portals or direct insurer contact to resolve billing errors and support clean claim processing. Type of Opportunity: Full time Job Exempt: No Job is based: Remote Workers New Mexico Work Shift: Days (United States of America)Responsibilities:
- Prepare, process, and submit accurate and timely insurance claims for all payer types in accordance with payer requirements and department policies.
- Resolve pre‑billing edits and route accounts to appropriate departments when additional review is needed to ensure clean claim submission.
- Review and clear assigned work queues promptly to meet key performance indicators.
- Document all account activity in alignment with PHS policies and procedures.
- Contact insurance companies, patients, and employer groups to obtain required information for claim submission.
- Notify leadership of billing issues involving internal departments or contracted vendors.
- Submit both electronic and paper primary and secondary claims, including required HIPAA‑compliant attachments, medical records, and supporting forms.
- Stay current on billing procedure changes that impact claim processing or reimbursement.
- Operate effectively within multiple computer systems, including Epic, nThrive, FISS/DDE, payer portals, and Microsoft Office Suite.
- Contribute positively as a team member through strong communication, active participation in meetings, and collaborative relationships across PHS departments.
- Ensure goals are met in accordance with PHS policies, CMS regulations, and HIPAA confidentiality standards.
- Perform additional duties as assigned.
Qualifications:
- High School Diploma or GED required.
- Less than 1 year of clerical or customer service experience preferred.
- Passion for supporting an organization dedicated to improving patient experiences and community health.
- Proficiency with Microsoft Office Suite required.
- Strong organizational, problem‑solving, verbal and written communication skills with excellent attention to detail.
- Ability to work effectively in a team environment with a strong work ethic and positive collaboration skills.
- Ability to prioritize and manage a high‑volume workload in a fast‑paced environment with frequently changing payer regulations.
- Basic knowledge of ICD‑10, HCPCS, CPT, revenue codes, UB‑04/HCFA‑1500 claim forms, and electronic transactions (837/835) preferred.
- Basic understanding of coordination of benefits, Medicare MSPQ, and major payer submission requirements preferred.
- General knowledge of revenue cycle processes.
- Ability to maintain a HIPAA‑compliant, confidential home workspace with reliable high‑speed internet (minimum 25 Mbps download / 10 Mbps upload).
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.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.