Medical Claims Specialist

Claims Specialist
Hours of work - M-F - 8-5 p.m.
Pay $20-23 per hour
* Must have DPS Level I fingerprint clearance to be considered.

Job Summary:
Responsible for preforming all levels of claims processing and review.

Job Responsibilities:

• Prepares all claims for billing, ensuring all claims are valid and authorized per the contracts. Includes running pre-billing reports to review for accuracy and running non-billable services report to ensure all billing is captured. Non-billable service reports should be communicated to Program Directors.
• Claims submission to Commercial plans, AHCCCS and Regional Behavioral Health Authority (RBHA), both contracted and non-contracted, for final resolution.
  • Ensures accurate and timely filing.
• Reprocessing of denied claims with follow up to paid resolution/adjustment
  • Recognizing and reporting trends
  • Validates NPI/Tax ID
  • Validates payor ID
• Departmental goal is to be under 120 days for file rejections and denied claims
• Works with EHR systems and Internal Departments
• COB/TLP claims processing
• Appeals and Grievances
• Self-pay plan review/billing
• Payment posting
• Ensures claim files are submitted accordingly. Submission should not exceed 30 days from initial service date or 60 days for claim rejections and/or denials
• Produces reports for internal and external customers and assists in the preparation of presentations for upper management and providers
• Attends meetings related to the claims system
• Completes required trainings
• Maintains current knowledge of Billing Rules and Guidelines.
• Create and maintain timely guidelines for all payers
• Knowledge of CPT, ICD-10, HCPC codes/coding
• All other duties as deemed necessary
• Maintains an approved schedule and acceptable level of attendance.

QUALIFICATIONS:

• Education - HS/GED
• Certification - Certified Professional Coder or AAPC/AMA Certification preferred
• Experience -

• 5 years claims processing experience preferred.
• Behavioral Health billing experience preferred.

• REQUIRED:

• 21 years of age
• Current, valid Arizona Driver's License, 39-month Motor Vehicle Report and proof of vehicle registration and liability coverage to meet insurance requirements.
• Must have DPS Level I fingerprint clearance card
• First Aide, CPR certification (Employer provides)
• Initial current negative TB test result, within the prior 12 months. (Employer provides)

Please send resumes to Sam@thetempconnection.com
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