Job Information

Presbyterian Healthcare Services MANAGER INSURANCE BILLING in Albuquerque, New Mexico

Type of Opportunity: Full Time

FTE: 1.000000

Exempt: Yes

Work Schedule: Days


Responsible for ensuring timely, accurate and compliant submission of all medical claims, including secondary billing and rebilling. Manages daily electronic billing processes, including pre-bill edits and claim rejections. Also, responsible for the management of Medicare and Medicaid accounts receivable follow-up, collections, denials and payment variances. Directs billing and collection activities in accordance with Presbyterian PFS policies and objectives under the direction of the Director of Patient Accounting and in accordance with CMS rules and regulations, and according to applicable Third Party Payer requirements and guidelines. Manages unbilled and accounts receivable by developing, analyzing, and implementing strategies to improve clean claim rates and gross days outstanding. Responsible for ensuring accounts are paid correctly and appropriate discounts are applied. Manages Medicare credit balances to ensure compliance with CMS requirements in reconciling, reporting, and returning Medicare overpayments.

*Ensures accurate, timely and compliant billing in accordance with CMS guidelines. Manage quality and performance standards by monitoring billing reports, developing new methods and processes, and coordinating resources to improve collection efficiency and effectiveness.

*Manage billing performance indicators including billing turnaround, percentage clean claims, secondary payer billing and average time to pay clean claim.

*Performs random review of claims, problem bills and/or returned claims/correspondence, to determine reason(s) for and resolution of problems.

*Responsible for Medicare credit balance reporting. Prepares and submits quarterly CMS 838 Form to report Medicare credit balances.

*Responsible for oversight of the development and maintenance of department policies and procedures. Ensures that all processes are documented, in accordance with established PHS standards, to facilitate regulatory compliance and successful outcomes to internal/external review and audits.

*Identifies and resolves complex issues related to patient billing process and related collection activities.

*Leads team in a manner that ensures high quality customer care focused on building and retaining valuable patient/payer/provider relationships and committed to the delivery of value added services. Includes efficient allocation of resources, goal setting, forecasting and flexibility to manage changes.

*Builds effective and strong team committed to delivering world-class customer care and achieving organizational goals.

*Provides direct supervision to the Patient Financial Services Billing team Supervisors. Proactively assists them in development of leadership skills. Oversees cross-training and ensures development and presentation of written competency appraisals for all employees. Annually delivers performance appraisals to each direct report.

*Acts as a principal liaison and corporate resource to provide coordinated, organized, customer-orientated services to all Presbyterian Health Service customers. This includes developing and maintaining positive working relationships with vendors and all local and regional PHS facilities.

*Ensures that the employment practices are consistent with the corporation's equal employment opportunity objectives. Responsible for the hiring, counseling and disciplinary actions of all direct supervised employees as needed. Works with supervisors to develop corrective action plans when required.

*Ensures that all team members are empowered to make business decisions within established guidelines, and that every directly supervised employee participates in periodic in-house training sessions.

*Assist with budget preparations, staffing and measurement development by coordinating with director and other managers to meet and exceed the goals and objectives of the work area consistent with organizational strategic objectives and process goals.

*Serves as lead communicator and interpreter to area regarding the organization vision strategy and performance.

*Performs other duties as assigned by the Patient Accounting Director. Manages and assists in Patient Financial Services projects as needed.

Bachelors degree in Business Administration or related field or equivalent experience in lieu of the required education in accordance with company standards is required. In addition, five (5) to seven (7) years of relevant experience is required, with a minimum of two (2) years supervisory experience. Relevant experience must include three (3) to five (5) years in medical healthcare billing and/or collections roles demonstrating increasing responsibilities. Proficient knowledge of medical terminology, ICD-9, CPT, HCPCS, and revenue coding required. Familiar with HCFA 1500 and UB92 claim forms and 837 electronic claims processing. Excellent verbal and written communication skills. Good organizational, people and management skills and the ability to function effectively under stress/in a fast paced environment.


Essential: * Bachelor Degree

Education specialization:

Essential: * Business

Competencies and skills:


  • SKILL-Ability to effectively interact with customers to understand their needs and explain data

  • SKILL-Microsoft Office

  • Planning and coordinating organizational change

  • Anticipating & Addressing Customer Needs

  • Educating Employees, Customers & Transferring Knowledge

  • Functioning as an Effective Contingent Member

  • Diagnosing & Resolving Problems

  • Acquiring & Applying Superior Skills to achieve Quality Outcomes

  • Functioning as an Effective Team Member

  • Organizational Skills

  • SKILL-Prioritize and manage a high volume workload.

  • Demonstration of high degree of independent problem solving and critical thinking skills.

  • SKILL-Demonstrate ability to work effectively in a team environment

  • 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.

  • SKILL-Written communication

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.

Requisition ID: 2020-14923

Street: 9521 San Mateo NE