Ambulance Revenue Cycle Specialist

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Presbyterian is seeking an Ambulance Revenue Cycle Specialist I. The Ambulance Revenue Cycle Specialist I follows-up, collects, and resolves all outstanding accounts receivable. Performs a variety of duties including accounts receivable follow-up, customer service, correspondence response, and daily reconciliation of activities; Meets established guidelines to ensure timely and accurate reimbursement for all billed charges. Analyzes and validates accuracy of all 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 claims billing and adjudication. Meets time guidelines to ensure timely and accurate reimbursement for all billed charges. As an expert in the ambulance revenue cycle field, actively participates in the training and education of peers and those outside the department

Some key responsibilities include:

• Performs accounts receivable follow-up activities for their assigned payers/accounts using daily aged account work queues and/or A/R reports.
• 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.
• Maintain workflow consisting of outstanding accounts assigned. Responsible for following-up on all accounts listed in the workflow until resolved.
• Refer accounts to Supervisor for write-off, agency, or attorney referral.
• Must work closely with all outside agencies contracted and assist them with account resolution for any accounts assigned to them by ARC Supervisor or Manager.
• Performs accounts receivable credit balance reimbursement analysis to determine if reimbursement, allowances, and patient payments received are correct.
• Responsible for contacting insurance companies, patients, employers, etc. to resolve any over payment issues that require their assistance.

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.
• Six-months to one-year experience in a computerized accounts receivable system preferred.
• Short-term training in business office process and procedures preferred.
• PC experience with Microsoft Office Word and Excel.
• Excellent organizational, problem solving, verbal, written communication, and ability to interact with other functional areas required.
• Demonstrated ability to work effectively in a team environment.
• Must be able to prioritize and manage a high volume workload.
• Knowledge of ICD9/ICD10 and HCPCS

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.