Claims Specialist - Tucson, AZ (Corporate-Bonita)
About The Position
Under direction of the Claims Manager, the Claims Specialist is responsible for performing all levels of claims processing and review.JOB RESPONSIBILITIES: Claims submission to Commercial plans, AHCCCS and Regional Behavioral Health Authority (RBHA), both contracted and non-contracted, for final resolution. Ensures accurate and timely filing. Reprocessing of denied claims with follow up to paid resolution/adjustment. Recognizing and reporting trendsValidates NPI/Tax ID Validates payor IDWorks with EVOLV systems and Internal Departments.COB/TLP claims processing.Appeals and Grievances. Self-pay plan review/billing.Payment posting.Produces reports for internal and external customers and assists in the preparation of presentations for upper management and providers. Communicates with Insurance representatives for updates and changes Via phone/WebEx/trainings. Responds to questions/situations regarding claims issues and provides information and resolution to the provider’s satisfaction. Attends meetings related to the claims system. Completes EVOLV trainings. Maintains current knowledge of Billing Rules and Guidelines. Knowledge of CPT, ICD-10, HCPC codes/coding. Maintains an approved schedule and acceptable level of attendance.Performs other duties as assigned or necessary it relates to the general nature of the position.
Requirements
- High School diploma or GED required.
- 5 years of claims processing experience preferred.
- Minimum 18 years of age
- DPS Level I fingerprint clearance (must possess upon hire and maintain throughout employment)
- CPR, First Aid, AED certification, if required (must possess upon hire and maintain throughout employment).
- Current, valid Arizona Driver’s License and 39-month Motor Vehicle Report and proof of vehicle registration liability insurance to meet insurance requirements, if required.
- Initial current negative TB test result, if required (Employer provides).
Nice To Haves
- Behavioral health billing experience preferred.
- Certified Professional Coder or AAPC/AMA Certification preferred.
Responsibilities
- Claims submission to Commercial plans, AHCCCS and Regional Behavioral Health Authority (RBHA), both contracted and non-contracted, for final resolution.
- Ensures accurate and timely filing.
- Reprocessing of denied claims with follow up to paid resolution/adjustment.
- Recognizing and reporting trends
- Validates NPI/Tax ID
- Validates payor ID
- Works with EVOLV systems and Internal Departments.
- COB/TLP claims processing.
- Appeals and Grievances.
- Self-pay plan review/billing.
- Payment posting.
- Produces reports for internal and external customers and assists in the preparation of presentations for upper management and providers.
- Communicates with Insurance representatives for updates and changes Via phone/WebEx/trainings.
- Responds to questions/situations regarding claims issues and provides information and resolution to the provider’s satisfaction.
- Attends meetings related to the claims system.
- Completes EVOLV trainings.
- Maintains current knowledge of Billing Rules and Guidelines.
- Knowledge of CPT, ICD-10, HCPC codes/coding.
- Maintains an approved schedule and acceptable level of attendance.
- Performs other duties as assigned or necessary it relates to the general nature of the position.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
