Ambulance Revenue Cycle Specialist I

Now hiring an 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

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

Full Time - Exempt: No
• Job is based 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:

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.

• 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

Education Essential: High School Diploma or GED

• 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. 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.
• 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.
• 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.
• 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.
• 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.
• Manages workflow consisting of accounts assigned, and external correspondence, relating to overpayments (or incorrect payments) made by insurance payors or patients within established timeframes.
• Responsible for contacting insurance companies, patients, employers, etc. to resolve any over payment issues that require their assistance.
• 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.
• Must work closely with all ARC areas and teams regarding discrepancies in charges, payments, allowances, etc. posted to accounts.
• 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.
• Responsible for daily claims interface, uploading and monitoring of daily maintenance reports to control unbilled insurance by assigned work queue. Analyzes, monitors and resolves pre-billing compliance. Reviews files daily and corrects errors on final bills.
• Ensures that goals and objectives are met in conformity with PHS policies and procedures and Medicare compliance rules and regulations. Stays informed of changes in billing procedures that impact processes and/or reimbursement effectiveness.
• Uses on-line policies and procedures to ensure accurate and consistent processing of claims. Submits adjustments, appeals and Fair Hearing documentation when applicable.

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.