• Claims Specialist

    Job Locations US-AZ-Tucson
    Job ID
    2018-1534
    Category
    Administrative/Clerical
    Type
    Regular Full-Time
    Work Hours
    8:30 AM - 5:00 PM
    Travel
    None
    Field
    Mental and Behavior Health
  • Overview

    Do you have experience with Commercial and AHCCCS insurance billing and review? We need a pro for our Behavioral Health claims team!  Our office is located on the east side of Tucson, AZ.

    Responsibilities

    • 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
    • Works with myEVOLV  Electronic Health Record system and Internal Departments
    • COB/TLP claims processing
    • Appeals and Grievances
    • Self-pay plan review/billing
    • Payment posting
    • Produces reports for internal and external customers and assists in the preparation of presentations for upper management and providers
    • Communicates with Insurance representatives for updates and changes Via phone/WebEx/trainings
    • Responds to questions/situations regarding claims issues and provides information and resolution to the provider’s satisfaction
    • Attends meetings related to the claims system    
    • Completes EVOLV trainings
    • Maintains current knowledge of Billing Rules and Guidelines.
    • 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 –

    o   5 years claims processing experience preferred.

    o   Behavioral Health billing experience preferred.

     

    ·         Regulatory -

    o   21 years of age

    o   Current, valid Arizona Driver’s License, 39 month Motor Vehicle Report and proof of vehicle registration and liability coverage to meet insurance requirements.

    o   Eligible for DPS Level I fingerprint clearance.

    o   First Aide, CPR  certification (Employer provides)

    o   Initial current negative TB test result, within the prior 12 months. (Employer provides)

     

    KNOWLEDGE, SKILLS AND ABILITIES:

    ·         Language - Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

    ·         Technology - Computer literacy to include advanced knowledge of Microsoft Office Systems, Word, Outlook and Excel applications; Electronic Health Record (EHR) and other databases.

     

    • PHYSICAL DEMANDS:  The conditions herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform.
    • Sufficient physical ability and mobility to work in an office setting; to stand sit for prolonged periods of time; occasionally stoop, bend, kneel, crouch, reach and twist; to lift, carry, push, and/or pull light to moderate amount of weight; to operate office equipment requiring repetitive hand movement and fine coordination including use of a computer keyboard or laptop; and verbally communicate to exchange information
    • Ability to drive a vehicle
    • Vision: See in the normal visual range with or without correction
    • Hearing: Hear in the normal audio range with or without correction

     

     

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