Analyzes and adjudicates health benefit claims and performs other related work as required or assigned.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- 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
- 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
- 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
Please submit resume via this recruiting announcement.
Care1st Health Plan Arizona - 2 years ago