Arizona Priority Care ยท 18 hours ago
Claims Examiner
Chandler, AZ
Full-time
Hybrid
Entry, Mid Level
$21/hr - $23/hr
1+ years expArizona Priority Care (AZPC) is an Integrated Provider Network focused on providing Whole-Person care to Senior and Medicaid populations. The Medical Claims Examiner is responsible for processing medical services claims, ensuring accuracy, and responding to provider or client inquiries in a timely manner.
Health CareHospitalMedicalPrimary and Urgent Care
Responsibilities
Processing of professional and facility medical services claims by reviewing and inputting data into the claims payment system using standard policies, procedures and guidelines
Must meet quality/accuracy standard of 95% and production standards of 100-125 claims/day
Forward claims to appropriate departments for Med Review, Eligibility, etc
Verification of coverage and contract interpretation
Pursues and follows up on open and pended claims promptly and independently
Researches and investigates claims with multiple coverage and complexity to determine if claim is payable in accordance with various policy provisions. If payable, determine eligible payee(s) and payment amounts. If not payable, develop detailed letter of explanation based on policy provisions and claim documents
Critical thinker who can maintain focus and stay on task with minimal supervision
Participates and practices principles of continuous quality improvement
Qualification
Required
High school diploma required; college degree preferred
Minimum 1-3 years of medical claims processing experience in Managed Care
Strong experience and knowledge of medical claims, Medicare/Medicaid guidelines, ICD-10, HCPCS / CPT Coding, HCFA 1500's & UB04's
Strong communication, analytical, organizational and problem-solving skills
Excellent time management skills
Proficient with Microsoft applications (Word, Excel, Outlook) and database systems
Must be able to read and interpret documents such as processing and procedure manuals, medical terminology and claims rules and regulations to appropriately develop the claim
Ability to write routine, professional correspondence using correct grammar and spelling
Must be able to identify and define problems; collect data; establish facts and draw valid conclusions
Must be able to consistently interact with customers in a professional and respectful manner
This role requires FT in-office presence for the first 60 days of employment. Hybrid schedule available after initial training period
Preferred
College degree preferred
EzCap Claims payment systems knowledge is a plus but not required
Company
Arizona Priority Care
Arizona Priority Care is a medical management service that provides a physician-led network of primary care physicians.
51-200 employees
Funding
Current Stage
Growth StageRecent News
GlobeNewswire News Room
2024-11-25
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