Medical Claims Specialist

Claims Specialist - this is an in office position.
Hours of work - M-F - 8-5 p.m.
Pay $20-22 per hour
REQUIRED: Must be able to obtain a DPS Level I fingerprint clearance upon offer.

Job Summary:
We are seeking a detail-oriented and experienced Medical Claims Specialist to join our growing team. The ideal candidate will have a strong understanding of CPT, ICD-10, and HCPCS codes and coding practices. If you have excellent organizational skills, attention to detail, and the ability to process claims efficiently, we would love to hear from you!

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

• Education – HS/GED
• Certification – Certified Professional Coder or AAPC/AMA Certification preferred
• Experience –
• 5 years claims processing experience preferred.
• Behavioral Health billing experience preferred.
• Current, valid Arizona Driver’s License, 39-month Motor Vehicle Report and proof of vehicle registration and liability coverage to meet insurance requirements.
• Must be able to obtain a DPS Level I fingerprint clearance card upon acceptance of offer
• First Aide, CPR certification (Employer provides)
• Initial current negative TB test result, within the prior 12 months. (Employer provides)