Billing Processor

• Verifies member coverage, benefits and services allowed for Medicare, Commercial and AHCCCS payors.  
• Confirms health insurance coverage for coordination of benefits to process claims
• Works with payors to request and resolve Prior Authorizations discrepancies.
• Resolves rejected and denied billing errors.
• Applies provider contract provisions to determine if claim is payable or denied. 
• Determines if denied claims related to rendering provider, service location, coordination of benefits, refunds or adjustments.
• Reviews medical and behavioral claims, post payment or denial codes within established department guidelines and standards
• Maintain records, files, and documentation as appropriate
• Maintains billing, explanation of benefits, and Receipts filing system and records retention.
• Runs denials and cash receipts reports.
• Posts receipts and Explanation of Benefits (EOB) via manual posting. 
• Routinely monitors and ensures eligibility segments are documented correctly in NextGen.
• Meet department production and quality standards
• Performs other related duties in accordance with agency growth and changes.

Additional Essential Duties and Responsibilities for Billing Processor II

• Reviews and processes inbound 835 electronic response files (ERAs) for the assigned Medicaid payer. 
• Reviews and resolves claim discrepancies and errors prior to posting the assigned Medicaid ERA.
• Responsible to communicate and resolve any posting errors with NextGen directly.
• Assigns denied and rejected billing claims to their Medicaid team members.
• Prepares and reports payor payment trends for the assigned Medicaid payer. 
• Point of contact for communicating directly with the Medicaid provider representative.
• Point person to communicate and resolve denials and rejections for the assigned Medicaid payer.
• Reconciles Medicaid payer monthly payments to EFTs and communicates discrepancies to the supervisor.
• Assists billing team members with denied and pended billing errors.
• Assists with training specific to the assigned Medicaid payer.

Additional Essential Duties and Responsibilities if Certified Professional Coder

• Answer calls and emails related to coding.
• Review denial notes to determine correctness in diagnosis, modifier & CPT code 
• Assist providers in selecting correct CPT codes
• Assist Data Validation Audits

Billing Processor I:

• 3 years billing & claims processing experience 

Billing Processor II:

• A minimum of 5 years billing & claims experience AND;
• A minimum of 1 year processing claims as assigned to the primary Medicaid ERA funder 

Certified Professional Coder

• Active AAPC Certification

Certifications:

• Certified Coder, preferred

Additional Requirements:

• Valid Arizona Drivers license, proof of current insurance and willingness to use personal vehicle.
• Clean Motor Vehicle Record - no more than 2 moving violations or a license suspension in past 3 years.

Skills:

• Bilingual a plus.
• Ability to interact effectively with other service providers.
• Intermediate to advanced computer skills using MS Office products, Word, Excel, Access, etc., importing/exporting data to/from applications.
• Ability to communicate effectively both orally and in writing