Presbyterian Healthcare Services

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at Presbyterian Healthcare Services

Posted: 4/5/2019
Job Status: Full Time
Job Reference #: 17987
Keywords: system

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: No

Work Schedule: Weekday Schedule Monday-Friday

Location: Rev Hugh Cooper Admin Center


* High School Diploma or GED

High School education (G. E. D.) required. Extensive training in claims processing with a minimum of three to five years experience in medical claims processing. Demonstrated ability to communicate effectively in person, via telephone and in writing. Demonstrated ability to sustain quality and production standards Requires strong organizational skills, and the ability to analyze reports and system processes, and a thorough knowledge of reimbursement methodologies (i.e. DRG, Per Diem, Fee schedule, Capitation, etc.) Demonstrated ability to work effectively in a team environment.


Competencies and skills:
* SKILL-Ability to effectively interact with customers to understand their needs and explain data
* SKILL-Microsoft Office
* SKILL-Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff using strong dialogue and customer service competencies. \n
* SKILL-Written communication


Responsible for performing complex research functions within the Claims Department for multiple lines of business for claims that could involve other insurance, including but not limited to auto insurance, workers compensation and other health insurance. This includes researching all written and verbal inquiries from members, providers, and other insurance carriers, and would also include handling complaints and acting as a liaison to providers for special claims handling and/or adjustments. Processes and adjusts hospital and medical claims that involve other insurance according to established business goals for quality and timeliness of claims processing for multiple lines of business. Uphold departmental and corporate Policy and Procedure and State and Federal Regulations governing the adjudication of claims. Update Amisys COB records for all lines of business


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!