Presbyterian Healthcare Services

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REIMBURSEMENT INTEGRATION AUDITOR I - PROVIDER REIMBURSEMENT

at Presbyterian Healthcare Services

Posted: 1/30/2019
Job Status: Full Time
Job Reference #: 15637
Keywords: medical

Job Description

About Us

Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of eight hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state’s largest private employer with approximately 11,000 employees.

 

Presbyterian’s story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.

 

We are part of New Mexico’s history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

 

Job Description 

Type of Opportunity: Full Time

FTE: 1.000000

Exempt: Yes

Work Schedule: Weekday Schedule Monday-Friday

Location: Rev Hugh Cooper Admin Center

 

Education:
Essential:
* Associate Degree

Education specialization:
Essential:
* Business

Credentials:
Essential:
* Certified Professional Coder
 

Minimum Requirements:
Bachelors degree in business administration or health care field preferred. National Coding Certification required or required to be obtained within 1 year of employment. Knowledge of medical terminology and regulatory guidelines such as CMS, DOI, HSD, etc. Three to five years of extensive claim processing knowledge including experience with varied claims processing systems. Extensive knowledge in negotiation techniques required. One to three years experience in provider relations, provider contracting, or customer service in a managed care organization. Strong working knowledge of risk sharing programs and different reimbursement methodologies i.e. capitation, DRG, Relative Value Systems, etc. Must demonstrate strong verbal, written communication, strong interpersonal skills, and ability to inter>

Summary:
Validation of claims payment according to contractual terms in the practitioners and providers agreements, which requires extensive knowledge of contractual agreements. Coordination of any corrections to configuration with various departments in the event of incorrect provider payment. Working knowledge of all structural and configuration relationships between claims, correct coding, contract interpretation, reimbursement methodologies and configuration. Serve as department subject matter experts in any coding issues by maintaining a national coding certification. Serve as system wide subject matter experts for all reimbursement issues, which includes maintenance of all fee schedules used by Presbyterian for reimbursement of claims. Active participants in all regulatory audits. Perform moderate to complex levels of claim auditing functions for both internal and third party payers/customers in support of daily operations using standard policies. Active negotiations with non-participating providers to reduce health care costs and to aid in the prevention of balance billing of health plan members.

 

Benefits

Benefits are effective day-one (for .45 FTE and above) and include:

  • Competitive salaries<\>

  • Full medical, dental and vision insurance<\>

  • Flexible spending accounts (FSAs)<\>

  • Free wellness programs<\>

  • Paid time off (PTO)<\>

  • Retirement plans, including matching employer contributions<\>

  • Continuing education and career development opportunities<\>

  • Life insurance and short/long term disability programs<\><\>

     

    About New Mexico

    New Mexico’s unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich life>Santa Fe’s artists, and you get an eclectic mix of people, places and experiences that make this state great.

     

    Cities in New Mexico are continually ranked among the nation’s best places to work and live by Forbes magazine, Kiplinger’s Personal Finance, and other corporate and government relocation managers like Worldwide ERC.

     

    New Mexico offers endless recreational opportunities to explore, and enjoy an active life> 

    AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!