Revenue Specialist

Presbyterian is seeking a Revenue Specialist to join our team.

Revenue specialists are primarily responsible for posting corrections and unit revenue reconciliation. Provide knowledgeable, responsive, and timely resolution to departmental billing, charge posting discrepancies. Responsible for entering patient charges, reviewing, and reconciling daily transaction reports to ensure completeness and accuracy of all charge entries for patients. Responsible for monitoring changes to the individual charge master's within his/her respective business unit. Communicates with revenue, finance, and compliance to ensure that billing, coding, and documentation practices are current and compliant. Ensure that all charges are entered accurately and conform to compliance issues set by finance regulatory agencies. Responsible for coding modifiers related to charges. Stays current with regulatory requirement and provide education to clinicians and leaders. Responsible for quality management of documentation and billing for adherence to regulatory requirements.

Type of Opportunity: .5/20hr days
Work Schedule: 8 Hour Days

We're all about well-being, starting with yours.
Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.

How you grow, learn and thrive matters here.

Educational and career development options, including tuition and certification reimbursement, scholarship opportunities

This position is eligible for the Northern New Mexico differential of $4.00 per hour. (This differential may be adjusted or discontinued based on business requirements.)

• High School diploma/GED required.
• One to three years experience in a healthcare reimbursement/business office environment to include data entry, clerical and financial functions, and billing and account reconciliation.
• Systems operations knowledge of at least one patient accounting system EPIC and other revenue cycle systems. PC experience with Microsoft Office Word and Excel.
• Knowledge of CPT, ICD-10 and HCPCS coding.

• Responsible for reviewing, updating, and posting charges

• Communicate with revenue and finance to ensure charge entry and posting comply with CMS, DOH, TJC, and other regulatory agencies

• Listen, analyze, answer, resolve, and coordinate charge master and billing inquiries across network service areas

• Document responses and resolutions to charge master inquiries in information systems for tracking and reporting

• Access online systems and hard copy documentation to resolve charge master issues

• Maintain effective communication with clinical staff, managers, supervisors, administrative assistants, and finance

• Review billing and charge master transaction summaries daily for accuracy and completeness

• Reconcile daily billing activity to ensure correct charge entry

• Maintain confidentiality of all patient information

• Establish and maintain relationships with revenue, compliance, and finance teams

• Assist PHS system personnel in researching questions, inquiries, and statistical checks

• Maintain department statistics and compile data for clinician and department scorecards

• Respond to daily inquiries regarding financial statistics, billing, auditing, and charging

• Act as liaison to Manager, Finance/Revenue, and Compliance for auditing, coding, compliance, and training issues

• Perform quality assurance audits of patient accounts for regulatory compliance, accurate coding, and proper documentation

• Identify and resolve compliance and reimbursement issues to ensure accurate claims submission

• Develop and deliver training and technical knowledge to Presbyterian employees

• Assess learning and performance needs of staff and target audiences

• Create training materials and provide initial and ongoing staff training

• Identify billing and collection practices inconsistent with contracts and regulations

• Summarize audit findings and provide recommendations to management

We're all about well-being, starting with yours.
Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.

Learn more about our employee benefits.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system comprised 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 13,000 employees - including more than 1,200 providers and nearly 3,500 nurses.

Our health plan serves more than 640,000 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.