Arizona Priority Care · 2 hours ago
Claims Coordinator
Chandler, AZ
Full-time
Hybrid
Entry Level
$19/hr - $21/hr
1+ years expArizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations. The Claims Coordinator will support various areas of the Claims Department, including documenting and analyzing medical documents, assisting with provider communications, and resolving claims issues.
Health CareHospitalMedicalPrimary and Urgent Care
Responsibilities
Review and analyze claims in AZPC’s processing system (EZ-CAP) for appropriate Prior Authorization’s and/or Case Management ID’s for processing of claims
Working data integrity reports
Communicate with providers in a courteous and timely manner
Prepare medical records for scanning and routing to the appropriate department(s)
Scan medical records into the document management system
Analyze claims to determine if medical records are required for processing
Review medical records for verification of contracted or non-contracted ordering and/or referring providers
Provide follow-up on outstanding review requests
Process denied claims based on reviewer determinations, or route to examiners as appropriate
Perform other document control and management activities as assigned including but not limited to, opening and sorting mail and data entry of claims
Identify and communicate process improvement opportunities to management team
Perform eligibility validation inquiries and documentation with a high degree of speed and accuracy
Handles incoming calls, inquiries or concerns in a positive and helpful manner, seeking resolution and follow-up within 24 hours
Process daily incoming documents received via mail and fax
Responding to Provider inquiries in a timely and professional manner
Perform claim data integrity validation checks
Follow established policies, formats, procedures and timelines to complete assigned tasks
Perform other duties as assigned
Qualification
Required
High school diploma or equivalent (GED)
Minimum 1 year of medical claims processing experience required
Strong experience and knowledge of Claims, Medicare/Medicaid guidelines, ICD-9, HCPCS / CPT coding, HCFA 1500's & UB04's
Knowledge of healthcare terminology
Knowledge of various medical claim forms i.e., Professional and Facility
Strong computer skills including touch typing and experience with Microsoft applications (Word, Excel, Outlook)
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
Demonstrate personal initiative, team spirit and service orientation while maintaining a positive, caring and professional attitude
Strong organizational skills and the ability to work independently and under pressure on time-sensitive materials
Interacts and communicates effectively
Excellent time management skills
Strong attention to detail
Must be able to work under guidance of Team Lead
This role requires FT in-office presence for the first 60 days of employment. Hybrid schedule available after initial training period
Preferred
Prior experience in customer service
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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