About This Opportunity
Support the Claim Department by processing AHCCCS claims for VHS Phoenix Health Plan. Processing, adjusting, and editing the most complex of ALL claims types and may be asked to provide technical assistance to less experienced claims analysts in the absence of the team leader.
Accurately and efficiently processes, adjusts, edits and refunds all assigned claim types for payment in accordance with PHP/CC standards.
Accurately and efficiently pends provider claims for later resolution in accordance with PHP standards.
Monitors the number of outstanding pended claims and adjudicates correctly within timeframes established by department policies and procedures.
Correctly denies payment of provider claims that do not meet submission guidelines as established in PHP/CC policies and operating procedures. Correctly explains denials on all claims not submitted in the correct format or without required documentation.
Accurately and efficiently corrects claims pended by AHCCCS within specific timeframe.
Researches, investigates, and adjusts complex claims identified from telephone calls, correspondence submitted by providers and other parties, and those associated with the formal grievance process. Proficiently adjusts any claim processed by self or other analysts.
Seeks technical assistance and guidance in a timely fashion from the team leader as necessary after first consulting the Claims Processing Manual or other claim processing reference material.
Prepares for and participates in audits and reviews performed by AHCCCS.
Identifies and brings to the attention of the team leader those claims considered to be unusual in terms of dollar amount, provider/service type, dates and/or location of service, member eligibility, or that do not meet or appropriately addressed by department policies and procedures.
Special Skills: Must be highly organized, professional, and have excellent verbal communication skills. Must be proficient with claims processing systems. Ability to use IBM based personal computers, word processing, and spreadsheet software programs for Windows and DOS is preferred.
Minimum Education: High School Diploma or equivalent GED
Minimum Experience: Five years of prior work experience as a claims analyst, preferably in commercial healthcare, managed care, and/or AHCCCS related lines of business.
Preferred Experience: Analysts should be proficient in ICD-9, CPT, and HCPCS coding; strong data entry, 10-key and general numerical analytical skills are required. Previous customer service and claims experience required.
Schedule: Full Time
Shift: Day Shift
Hours: M-F, 8-5
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About Abrazo Health Care
Abrazo Health Care’s five acute care hospitals consist of Arrowhead Hospital, Maryvale Hospital, Paradise Valley Hospital, Phoenix Baptist Hospital and West Valley Hospital. Each hospital offers a broad range of medical services including internal medicine, general surgery, cardiology, orthopedics, obstetrics, women’s health, diagnostic imaging and emergency care. Outpatient services include outpatient surgery, laboratory, radiology and rehabilitation services. Additionally Abrazo includes Arizona Heart Hospital, a campus of Phoenix Baptist Hospital, known for its distinct reputation as a premier cardiovascular specialty hospital and center of excellence dedicated exclusively to cardiac and cardiovascular care.
For more information and opportunities, see Abrazo Health Care.