Claim Analyst II
Care1st Health Plan Arizona - Phoenix, AZ

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Analyzes and adjudicates health benefit claims and performs other related work as required or assigned.

QUALIFICATIONS:
  • High school diploma or GED
  • 3-4 years of claims processing (AHCCCS experience preferred)
  • Knowledge of CPT, HCPC, and ICD-9 codes, medical terminology and general billing guidelines
  • Experience in processing claims according to Medicaid and Medicare guidelines preferred
  • Ability to process CMS-1500 claims
  • Analytical skills to resolve complex claims
  • Strong multi-tasking skills and the ability to identify and trend processing/billing issues
  • Must be organized with a positive attitude
  • Ability to work as a team player in a professional, fast-paced environment
  • Able to communicate effectively and tactfully in both oral and written form
  • Excellent attendance a must Skills / Requirements
ESSENTIAL DUTIES AND RESPONSIBILITIES:
  • Accurately adjudicate claims in accordance with health plan guidelines, company standards, and company procedures
  • Maintain minimum production standards as set by Care1st Maintain a 98% or above financial accuracy rate and a 95% or above procedural accuracy rate
  • Review claims for appropriate information and accurate reimbursement
  • Prioritize and manage individual workflow as needed
  • Maintain completed and updated set of resource materials necessary for processing claims
  • Attend all company-mandated training and remain current with knowledge in the claims field
  • Assist with data entry of claims as needed
  • Other duties as assigned
CORPORATE INTEGRITY:
  • Understands and abides by all departmental policies and procedures as well as the organization’s Corporate Integrity Program.
  • Attends mandatory Corporate Integrity Program education sessions, as required for this position, including the annual mandatory Standards of Conduct class.
  • Participates actively in ensuring that all state and federal rules and regulations are followed as they apply to this position.
  • Abides by all applicable laws and regulations as mandated by state and federal laws and prevents being excluded or sanctioned from any state and/or federal programs as they pertain to healthcare.
  • Represents the organization in a positive and professional manner in the community.
  • Maintains organizational confidentiality at all times.
  • Complies with all organizational policies regarding ethical and compliant business practices.
  • Appearance is professional and exemplary at all times
Important Notes

Please submit resume via this recruiting announcement.

Care1st Health Plan Arizona - 2 years ago - save job - block
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