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Company: Presbyterian Healthcare Services
Location: Rio Rancho
Posted on: June 12, 2021

Job Description:

Type of Opportunity: Full Time
FTE: 1.000000
Exempt: No
Work Schedule: Days


Performs financial screening on hospital and medical group account activity to identify residual balances, high-deductible plan participants and self-pay patients

Requires thorough knowledge of assistance programs to include Community Benefit Application, Medicaid (PEMOSSA) application where applicable and other alternate resource programs in addition to full competency of Presbyterian policy for payment plan application

Research disputed account balances and resolve accounts with outstanding residual balances

Must possess in depth understanding of benefits administration of PHS contracts and their respective in and out of network arrangements

Comprehension of the pre-billing/pre-adjudication of claim filing to successfully identify out of pocket expense to counsel patient and/or families regarding financial responsibilities to Presbyterian

Escalates chronic no pay or bad debt accounts to supervisor

Refers patients without insurance coverage to the Financial Advocacy Center located at Main PHS for navigation of options to manage healthcare costs, including using the Market Place for obtaining health insurance coverage

Other duties as assigned

Customer Service and Caring Practices:


* Achieve exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools.

* Addresses and attempts to appropriately resolve complaints in the moment by using key words at key times

* Ability to manage conflict and appropriately request the help of a supervisor when appropriate 


Encounter Components:


* Calculate patient out of pocket expenses (copayment, coinsurance, residual, deductible etc.)

* Use workflow to adjust the DAR (Epic Dept Appointment Report) to alert registration staff of residual amounts for appointed patients

* In one on one patient interactions set expectation for payment when applicable

* Set up payment plans in Epic per guidelines

* Registration accuracy skills to insure correct coordination of

* Exceptional registration accuracy skills to identify errors and correct them as necessary. Serves as a resource to staff regarding account interpretations. Identify claims where filing errors have occurred and resubmit the claims to payors for consideration

Financial Accountabilities:


* Collects identified patient financial obligation amounts including residual balance if applicable

* In one on one patient interactions set expectation for payment when applicable

* Refers as appropriate to on site Financial Advocate, or for uninsured to the Financial Advocacy Center

* Follows PMG cash handling policies and balances daily

* Keeps current on PHS financial policies, including payment plans, programs and other forms of funding

Medical Record Components:


* Documents patient discussion, agreed upon outcomes and audit trail note in guarantor account notes or the auth/cert screen as applicable.

Patient Relations


* Comprehend quality service connection to patient satisfaction and reimbursement

Patient Safety


* Respond quickly to patients showing distress. Follow guidelines set forth by the Clinic Manger to alert the clinical team. Assist in any manner the clinic team directs.

* Ensure registration area, waiting area and walkways are clear of any unnecessary items and are clean and neat.

* Report any concern that may create a safety issue.

* Annual competency completion of Clerical Staff during a Code Blue

C.A.R.E.S Behaviors:


* Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter


Professional Requirements:


* Pass annual competency exam for all areas of responsibility.

* Attend Quarterly MSO meetings.

* Attend Staff meetings

* Attend Employee Forums


*Three to five years of healthcare experience in a physician office or hospital setting


*Prior billing office and collection experience preferred


*Significant provider and patient interaction experience




*Demonstrates a commitment to Presbyterian s Sense of Mission by role modeling CARES Behaviors and appropriate customer service techniques to perform patient education and act as a resource and advocate to our patients and members


*Requires detailed knowledge of operations in a medical practice in terms of what and how work is to be done as well as why it is done


*Familiarity with the Affordable Care Act and healthcare s role in assisting patients and patients families with health care costs


*Must be able to interpret data


*Comprehension of billing methodology for an integrated delivery system to include lab and other ancillary services in scope


Essential:  * High School Diploma or GED

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 Us
Presbyterian Healthcare Services is a 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, 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.
About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and 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 lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. 

Keywords: Presbyterian Healthcare Services, Rio Rancho , PATIENT FINANCIAL ADVOCATE, Other , Rio Rancho, New Mexico

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