• Submit and process medical insurance claims • Post payments and update billing records accurately • Follow up on denied, underpaid, or outstanding claims • Communicate with insurance companies regarding billing issues and claim status • Verify patient insurance eligibility and benefits • Follow up on required documents, signatures, and authorizations • Manage POCs, faxes, and other billing-related documentation • Assist with light EMR management and updates • Track patient billing and documentation status • Maintain accurate billing records and administrative workflows • Support additional administrative tasks as workload allows

• Reviews medical record documentation and accurately assigns appropriate ICD-9 -CM, ICD-10, CPT IV, and HCPCS codes utilizing the 3M software tools for all OP Work Types • The assigned codes must support the reason for the visit and the medical necessity that is documented by the provider to support the care provided • When applicable, apply the appropriate charges such as the Evaluation & Management, (E&M) level and injections and infusions, and/or other necessary requirements for Observation cases, using a third party software systems such as LYNX • Correctly abstract required data per facility specifications • Perform "medical necessity checks" for Medicare and other payers as required per payment guidelines • Responsible for monitoring and working of accounts that are Discharged Not Final Billed, failed claims, stop bills, and epremis as a team, ensure timely , compliant processing of outpatient claims in the billing system • Responsible to maintain established productivity requirements, key performance indicators established for 3M 360 CAC for CRS & Direct Code as well as ensure accuracy to maintain established quality standards • Remain abreast of current requirements of the Centers for Medicare & Medicaid Services, (CMS) to include National Coverage Determinations, (NCD) and Local Coverage Determinations, (LCD) guidelines, related to the assignment of modifiers, to ensure the submission of a clean claim the first time through • Maintains competency and accuracy while utilizing tools of the trade, such as the 3M encoder, Computerized Assisted Coding, (CAC) Medical Necessity software, abstracting system, code books, and all reference materials • Reports inaccuracies found in Coding Software to HIM Management/Supervisor, reports any potential unethical and/or fraudulent activity per compliance policy • Attends required system, hospital and departmental meetings and educational sessions as established by leadership, as well as completion of required annual learning programs, to ensure continued education and growth

Title: Remote Claim Edit Coder Location: Santa Fe, NM 87501 Full-time Remote Location Address: Remote Office Santa Fe, NM 87501 Compensation Pay Range: Minimum Offer $21.70, Maximum Offer $33.14. Now Hiring: Remote Claim Edit Coder Summary: Build your Career. Make a Difference. Presbyterian is hiring a skilled Remote Remote Claim Edit Coder to join our team. Type of Opportunity: Full-time Job Exempt: No Job is based: Remote Workers New Mexico Work Shift: Varied Days and Hours (United States of America) Responsibilities: Has the knowledge and ability and will be required to code all of the following: inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services for PMG specialty providers or demonstrate coding expertise in a specific specialty deemed a critical business need by PHS Coding Leadership using the ICD-9/10 CM and CPT-4 classification system. Ensures adherence to Hospital and Departmental Policies and Procedures Some key responsibilities include: - Must demonstrate knowledge of coding multiple areas of service and/or specialties or extensive experience in a specific specialty deemed a critical business need by PHS Coding Leadership. - Reviews patients entire current medical record, assigning appropriate codes including CPT, ICD and MS-DRG (as defined by UHDDS guidelines and CMS) to be used for financial reimbursement, research in accordance with Federal Regulations and Hospital and Departmental policies. - Accesses several systems via the computer to research the medical record when needed to complete the coding in a timely manner. - Takes responsibility for accounts receivable by looking for lost documents to insure all encounters are coded, including the generation of appropriate queries, as needed. - Maintains and disseminates up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area. This includes but is not limited to all ICD-9/10 CM, CPT-4, HCPCS, and DRG, APC and/or HHRG updates and changes. - Responsible for resolving any and all pre-bill edits, denials, etc. for assigned accounts. - Participates in all departmental in-services and updates to stay current with the accepted coding guidelines and improve personal knowledge of medicine and treatment. - Performs other functions as required. Qualifications: - High school diploma/GED required. - Must have any one of the following coding certifications at time of hire: HCS-D, CCS, CCS-P, CPC-H or CPC, or RHIT/RHIA with achievement of one of the coding credentials above within one year of hire. - One-three years experience as a coder required. - Must possess computer skills including, but not limited to, Word, Excel, PowerPoint. - Experience with an encoder preferred. - Experience with an Electronic Medical Record preferred. - Must be able to use the internet and other electronic resources for the purpose of research 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. We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services

Role Description Our client is seeking a detail-oriented and proactive Medical Billing and Claims Specialist to support billing operations, insurance follow-ups, and administrative workflows for a growing healthcare practice. This role is ideal for someone with strong medical billing experience who is comfortable working independently and managing multiple responsibilities in a remote environment. The Medical Billing and Claims Specialist will be responsible for: - Handling claims processing, payment posting, insurance verification, and follow-ups on denials, underpayments, and outstanding documentation. - Assisting with light EMR management, tracking patient status, and ensuring billing-related workflows remain organized and up to date. This role is especially important as the practice prepares for growth and plans to expand its clinical team in the coming months. Qualifications - Prior experience as a Medical Biller or similar healthcare billing role. - Strong understanding of medical billing workflows, claims processing, denials, and underpayments. - Experience working with multiple insurance companies and payer processes. - Familiarity with insurance verification and follow-up procedures. - High attention to detail and accuracy in documentation and billing tasks. - Ability to work independently with minimal supervision. - Strong organizational and time-management skills. - Clear and professional English communication skills. Requirements - Strict adherence to HIPAA compliance and patient confidentiality. - Ability to maintain organized billing and administrative workflows. - Comfortable handling sensitive patient and insurance information. - Must be proficient in speaking and writing English very clearly. - Must have relevant work experience. - Be able to submit an NBI clearance and/or Local Police Clearance background check before onboarding (mandatory). - Must be available for video meetings with your camera on (when needed). Benefits - Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication. - Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks. - HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients. - Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top-performing VA and increase long-term client retention. - Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule. - Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client. - Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to help you perform at your best. - Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.