Supervisor-Denials & Appeals

Overview

Now hiring a Supervisor-Denials & Appeals!

Presbyterian is seeking a Supervisor-Denials & Appeals to supervises and coordinates the daily activities of the Denial & Appeals Team to ensure that all third-party and government denials are captured and processed appropriately to maximize reimbursement. Directs appeal activities in accordance with Presbyterian PFS policies and objectives and in accordance with payer agreements and guidelines. Assists manager with the development, analysis and implementation of strategies to improve denial overturn rates and reduce overall denial rates, improving cash collections. Continuously reviews processes looking for ways to streamline and automate steps for greatest efficiency and effectiveness. Assists with root cause analysis on issues and works with operations to implement process changes to reduce denials.

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: Yes
• 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.

Preferred Qualifications:

• Two years experience in healthcare billing and/or collections roles required.

Qualifications

• One to two years of college level courses OR three years of healthcare business office experience in lieu of college level courses.
• Two years experience in healthcare billing and/or collections roles required. Proficient knowledge of insurance billing and reimbursement methodologies, including medical terminology, ICD-10, CPT and HCPCS codes required.
• Must be familiar with CMS 1500 and UB-04 claim forms, 837 electronic claims processing, and 835 electronic remittance processing.
• Demonstrated ability to communicate verbally and in writing to customers, providers and peers.
• Good organizational, people and management skills and the ability to function effectively and independently in a fast-paced environment.

Responsibilities

• Supervise the day to day work of the Denial & Appeals Team to ensure that all accounts are processed in accordance with established quality standards. Monitors system generated reports, quality audits and work queues, develops new methods and processes, and coordinates resources to improve collection efficiency and effectiveness. Produces denial reports and distributes to applicable areas.
• Assists manager with ensuring that all processes are documented, in accordance with PHS standards, to facilitate regulatory compliance and successful outcomes to internal/external review and audits.
• Identifies and resolves complex issues related to denials. Ensures internal and external issues that affect both PB and HB are properly addressed with all affected parties.

Benefits

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.

Maximum Offer for this position is up to USD $34.27/Hr. Compensation Disclaimer The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.