Claims Processor - Medicaid (AZ Remote)

Blue Cross Blue Shield of Arizona
United States, Arizona, Phoenix
2444 W Las Palmaritas Dr (Show on map)
Nov 21, 2024
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. This position requires work and residency in the state of Arizona. Purpose of the Job Claims Processors adjudicate incoming claims in accordance with policies, procedures, and guidelines (as outlined by the company) regulatory requirements and contractual agreements. Processors are subject to production and quality standards to help ensure claims are processed correctly the first time. Qualifications REQUIRED QUALIFICATIONS Required Work Experience 1+ years Required Education High School Diploma or GED Required Licenses N/A Required Certifications N/A PREFERRED QUALIFICATIONS Preferred Work Experience N/A Preferred Education Associate's Degree in general field of study Preferred Licenses N/A Preferred Certifications N/A ESSENTIAL job functions AND RESPONSIBILITIES Adjudicate claims according to regulatory, contractual and health plan requirements Pre-screen accuracy of EDI submissions through review of data elements in claims system Verify claim is not duplicate of previously submitted claim Keep updated with processing manual and other educational/training materials Know and adjudicate claims according to COB provisions Identify and refer TPL issues to appropriate department Identify and refer medical review claims to appropriate department Identify and refer potential FWA claims to appropriate department Identify opportunities for provider education Identify opportunities for process improvement, including auto adjudication Perform all other duties as assigned The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements Competencies REQUIRED COMPETENCIES Required Job Skills Claims processing, including UB, 1500 and dental Medical terminology CPT/HCPC and ICD10 coding Medicaid and Medicare Experience with multi-tasking and prioritzing Type 30 to 35 words per minute with 5% error rate or less Intermediate PC proficiency Strong oral and written communication skills Proficient spelling, punctuation and grammar skills Required Professional Competencies Maintain confidentiality and privacy Compose and dictate a variety of business correspondence Interpret and translate policies, procedures, programs and guidelines Capable of investigative and analytical research Navigate, gather, input and maintain data records in multiple system applications Follow and accept instruction and direction Establish and maintain working relationships in a collaborative team environment Required Leadership Experience and Competencies N/A PREFERRED COMPETENCIES Preferred Job Skills Type >35 words per minute with 5% error rate or less Intermediate knowledge of CPT, HCPCS and ICD9 claim coding Intermediate understanding of dental and medical terminology Intermediate comprehension of anatomy and medical practices Bilingual (Spanish/English) skill in written communication Preferred Professional Competencies Knowledge of a wide range of subjects pertaining to the organization's service and operations Preferred Leadership Experience and Competencies N/A Our Commitment AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group. Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.