Current jobs related to Title: Claims Medical Records Specialist - Phoenix - Arizona Health Care Cost Containment System

  • Medical Claims Specialist

    4 weeks ago

    Phoenix, Arizona, United States LHH Recruitment Solutions Full time

    Position Title: Medical Billing SpecialistCompany: LHH Recruitment SolutionsOverview: We are seeking a dedicated Medical Billing Specialist to join our team. This role involves managing follow-up and collections, as well as gathering essential information for efficient claims processing.Location: This position is based in Phoenix, AZ and requires full-time...

  • Claims Assessment Specialist

    4 weeks ago

    Phoenix, Arizona, United States Sedgwick Claims Management Services Full time

    Position Overview:As a Claims Assessment Specialist, you will be responsible for evaluating complex Workers Compensation claims on behalf of our esteemed clients. Your expertise will play a crucial role in determining the appropriate benefits owed to claimants.Key Responsibilities:- Conduct thorough analysis of Workers Compensation claims to ensure accurate...

  • Medical Claims Specialist

    3 weeks ago

    Phoenix, Arizona, United States SOUTHWEST BREAST AND AESTHETICS LLC Full time

    Job SummaryWe are seeking a highly organized and detail-oriented Medical Claims Specialist to join our team at Southwest Breast and Aesthetics LLC. As a Medical Claims Specialist, you will be responsible for accurately and efficiently processing medical claims, resolving billing issues, and maintaining accurate records.Key ResponsibilitiesClaims Processing:...

  • Medical Claims Specialist

    2 weeks ago

    Phoenix, Arizona, United States SOUTHWEST BREAST AND AESTHETICS LLC Full time

    Job SummaryWe are seeking a highly skilled Medical Claims Specialist to join our team at Southwest Breast and Aesthetics LLC. As a Medical Claims Specialist, you will be responsible for accurately and efficiently processing medical claims, resolving billing issues, and maintaining accurate records.Key ResponsibilitiesClaims Processing: Accurately and timely...

  • Medical Claims Specialist

    6 days ago

    Phoenix, Arizona, United States SOUTHWEST BREAST AND AESTHETICS LLC Full time

    Job SummaryWe are seeking a highly organized and detail-oriented Medical Claims Specialist to join our team at Southwest Breast and Aesthetics LLC. As a key member of our revenue cycle team, you will be responsible for accurately and efficiently processing medical claims, resolving billing issues, and maintaining accurate records.Key ResponsibilitiesAccurate...

  • Medical Claims Processing Support Specialist

    4 weeks ago

    Phoenix, Arizona, United States IQVIA Full time

    Position Overview:As a Medical Claims Processing Support Specialist, you will play a crucial role in assisting patients and healthcare providers by managing medical claims efficiently. This position is designed for individuals who are detail-oriented and possess a strong understanding of medical billing processes.Key Responsibilities:1. **Claims...

  • Medical Claims Support Specialist

    4 weeks ago

    Phoenix, Arizona, United States IQVIA Full time

    Medical Claims Support SpecialistContract Remote Position - Open to Remote Work in the USAs a leading global provider of commercial solutions, IQVIA possesses the expertise required to facilitate the delivery of healthcare products and services on both national and international levels. Our dedicated teams assist biopharma, medical device, and diagnostic...

  • Medical Claims Specialist

    1 week ago

    Phoenix, Arizona, United States SOUTHWEST BREAST AND AESTHETICS LLC Full time

    Job Title: Medical BillerAt Southwest Breast and Aesthetics LLC, we are seeking a highly skilled Medical Biller to join our team. As a Medical Biller, you will play a critical role in ensuring the accurate and timely processing of medical claims.Key Responsibilities:Accurate and timely data entry of electronic and/or hardcopy medical claimsInput billings and...

  • Claims Adjuster-1

    1 week ago

    Phoenix, Arizona, United States CopperPoint Insurance Companies Full time

    {"title": "Claims Adjuster-1 - Workers Comp Claims Specialist", "content": "Job SummaryCopperPoint Insurance Companies is seeking a skilled Claims Adjuster-1 - Workers Comp Claims Specialist to join our team. As a key member of our claims team, you will be responsible for analyzing and investigating medical-only workers' compensation claims to determine...

  • Claims Processing Specialist

    4 weeks ago

    Phoenix, Arizona, United States BCForward Full time

    Job OverviewBCforward is seeking a dedicated Claims Processing Specialist to join our team. This role is essential for managing complex claims within our organization.Key ResponsibilitiesThe Claims Processing Specialist will be responsible for:Effective Communication: Clearly and professionally conveying intricate information to stakeholders to ascertain...

  • Medical Claims Specialist

    5 hours ago

    Phoenix, Arizona, United States SOUTHWEST BREAST AND AESTHETICS LLC Full time

    Job SummaryWe are seeking a highly organized and detail-oriented Medical Biller to join our team at Southwest Breast and Aesthetics LLC. As a Medical Biller, you will be responsible for accurately and timely processing medical claims, managing billing and payment records, and communicating with internal and external representatives to resolve billing...

  • PIP Claims Specialist

    4 weeks ago

    Phoenix, Arizona, United States Sedgwick Full time

    PIP Claims SpecialistSedgwick, a leading provider of risk management and business solutions, is looking for a PIP Claims Specialist to enhance their team. This position focuses on the thorough investigation, negotiation, and resolution of personal injury protection (PIP) and medical payments (Med Pay) claims. The ideal candidate will possess extensive...

  • Senior Liability Claims Specialist

    4 weeks ago

    Phoenix, Arizona, United States Western International Staff Full time

    Position Overview:We are seeking a highly skilled and experienced professional for a temporary remote contract role that may transition to a permanent position. As a Senior Liability Claims Specialist, you will be responsible for managing commercial casualty claims, with a focus on litigated general liability cases.Key Responsibilities:1. Coverage Analysis:...

  • Claims Specialist

    4 weeks ago

    Phoenix, Arizona, United States RTA US Full time

    Job DescriptionRTA US is currently looking for a Claims Specialist to assist in managing claims processes effectively. This role offers a fantastic opportunity to collaborate with a vibrant team and acquire significant experience in the Insurance Sector. There is potential for extension or conversion for the right candidate.Position: Claims...

  • Integrated Absence Claims Specialist

    13 hours ago

    Phoenix, Arizona, United States Lincoln Financial Services Full time

    About the RoleWe are seeking a highly motivated and detail-oriented Integrated Absence Claims Specialist to join our team. As an Integrated Absence Claims Specialist, you will play a critical role in managing a workload of Short-Term Disability claims and their associated leaves.Key ResponsibilitiesConduct initial and ongoing interviews with claimants to...

  • Medical Records Specialist

    6 days ago

    Phoenix, Arizona, United States NavitsPartners Full time

    Job Title: Medical RecordsJob Summary:We are seeking a highly skilled Medical Records Specialist to join our team at NavitsPartners. The successful candidate will be responsible for managing and operating the medical records program, ensuring compliance with federal, state, and VA regulatory requirements.Key Responsibilities:Medical Records Management:...

  • Pharmacy Claims Specialist

    6 days ago

    Phoenix, Arizona, United States Onco360 Full time

    Pharmacy Adjudication SpecialistWe are seeking a highly skilled Pharmacy Adjudication Specialist to join our team at Onco360 Pharmacy in Scottsdale, AZ. This is a full-time position with a hybrid work style, requiring a strong understanding of pharmacy claims and benefits verification.Key Responsibilities:Adjudicate pharmacy claims, review claim responses...

  • Claims Specialist

    1 month ago

    Phoenix, United States Russell Tobin Full time

    Pride Global/Russell Tobin is currently seeking Claims Specialist to support our client. This is an excellent opportunity to work with a dynamic team and gain valuable experience in the Consumer Industry. Potential to extend or convert for the right candidate. Apply today for consideration!Position: Claims SpecialistLocation: Phoenix, AZ 85004Duration: 6+...

  • Medical Claims Specialist

    2 weeks ago

    Phoenix, Arizona, United States MBI Acquisition Corp Full time

    Job DescriptionCompany OverviewMBI Acquisition Corp is a leading provider of occupational healthcare services, with a strong commitment to delivering timely, compassionate care to individuals injured at work.Job SummaryWe are seeking an experienced Billing and Collections Expert to join our team. The successful candidate will be responsible for providing...

  • Operations Specialist

    2 weeks ago

    Phoenix, Arizona, United States Aveanna Full time

    Job SummaryAveanna is seeking an experienced Operations Specialist to join our team. As an Operations Specialist, you will be responsible for providing top-level customer service to internal and external clients, ensuring seamless clinical operational support activities.Key ResponsibilitiesManage medical records activities, including data entry, printing,...

Title: Claims Medical Records Specialist

3 months ago

Phoenix, United States Arizona Health Care Cost Containment System Full time

Job Summary:

This position is responsible for processing claims that are pended and have to be adjudicated per agency policies and procedures. The position requests medical documentation from providers, looks for consent forms, reviews the history for duplicates or duplicate payments, ensures the system is appropriately processing claims, and identifies inappropriate billing patterns, when are then reported to our audit unit or to the agency's Fraud Unit for review. The position looks for third party liability and ensures that the documentation needed is included with submissions. The position reprocesses Prior Authorization claims, supplements and links documentation, and recoups and voids claims. This position is also responsible for multiple special projects related to claims processing and adjudication. This position also performs statewide research in systems regarding records. Turning paper documents into a digital copy using scanning equipment. Duties typically include managing and storing files on a computer, raising concerns and issues with the scanning equipment to technicians and inspecting the quality of output regularly. Daily task assignments are based on immediate business needs.

This position in an in office only, reporting to the Medical Records Manager.

Major duties and responsibilities include but are not limited to:
* Processes claims that are pended (adjudicates); including requests medical documentation from providers, looks for consent forms, EOBs and Third-Party Liability, reviews the history for duplicates or duplicate payments, identifies inappropriate billing patterns and forwards to appropriate unit, ensures medical documentation is included with submissions, supplements and links documentation, recoups and voids claims.
* Ensure the system is appropriately processing claims, identifies problems/issues and notifies appropriate parties for resolution, identifies inappropriate billing patterns which are then reported to the Audit Unit or to the Agency's Fraud Unit for review. Verifies eligibility of claims, using agency's policies and procedures, coordinates claims that have Third Party Liability. Re-processes Prior Authorization Claims.
* Files original scanned document images in accordance with established guidelines to ensure accurate filing and facilitate timely retrieval of information. Ensures quality control by reviewing scanned rejected documents to identify/rescan poor quality document images to make sure all images entered into the system meet established quality standards and resolves inconsistencies.
* Reviews and links scanned, faxed and on-line supplemental documents to the appropriate claim using agency systems. Re-routing of unprocessed mail to appropriate destination and writes, types, or enters information into computer via MS Word, MS Excel or other departmental systems, using keyboard, to prepare documents or reports.
* System routing and processing of incoming RightFax documents for Prior Authorization and Claims gatekeeper in accordance with established guidelines to ensure accurate routing.
* Lifts, open, sorts, batches by claim type into predetermined batch size and prepares various forms for scanning by removing staples, paper clips, etc. and repairing documents as needed.
* Scans documents transcribing from paper formats into computer files. Verifies data to ensure accuracy while appropriately formatting, making adjustments for paper size/weight, color of ink, paper color, etc., to ensure acceptable image quality, and maintaining an even workflow. Responsible for logging document numbers automatically assigned during scanning for future retrieval.

Knowledge, Skills & Abilities (KSAs):

Knowledge:
* AHCCCS Programs & Eligibility Groups
* Administrative Rules and Regulations and AHCCCS Policies and Procedures
* Auditing and analysis procedures to determine compliance with AHCCCS requirements
* Medical terminology, CPT codes, ICD9 codes, HCPCS codes and CDT codes
* Third party liability laws as apply to State and Federal programs Principles of medical pricing (i.e., DME equipment, drugs, multiple surgical procedures)
* Digital Imaging system and procedures
* Inputting Medical/Dental documents to be into the system
* Document sorting, batching, routing, and coding practices/procedures/guidelines
* Thorough knowledge of all aspects of claims processing
* PMMIS and Docuware

Skills:
* Intermediate computer skills
* Oral and written communication
* Interpret rules and regulations, policies and procedures
* Analyze reports
* Professional interpersonal relationships
* Analyze problems and develop action plans for correction
* Quality assurance skills to ensure effectiveness of final product
* Microsoft windows (Excel and Word) or comparable software
* Operate and run a scanner

Abilities:
* Determine a pattern or inappropriate billing, which may indicate fraud
* Analyze system issues, elevating concerns to management
* Know when to report problems/issues in adjudication and when to proceed on their own
* Maintain a predetermined production level
* Provide technical training as required
* Work in a fast-paced environment independently and as a team
* Communicate effectively verbally and in writing
* Speed and accuracy to meet performance measurements
* Learn and closely follow established policies, procedures and guidelines

Selective Preference(s):

Arizona Drivers License

Minimum: One year experience in insurance processing & computer experience.

Preferred: Experience working in adjudication and working knowledge of medical coding. Proficient in Microsoft Office and above
average WPM typing skills.

Pre-Employment Requirements:

* Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
* Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
* Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.

If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Benefits:

Among the many benefits of a career with the State of Arizona, there are:
* 10 paid holidays per year
* Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
* Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
* Other Leaves - Bereavement, civic duty, and military.
* A top-ranked retirement program with lifetime pension benefits
* A robust and affordable insurance plan, including medical, dental, life, and disability insurance
* Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
* RideShare and Public Transit Subsidy
* A variety of learning and career development opportunities

By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

Learn more about the Paid Parental Leave pilot program here.