Claims Adjudication Specialist - REMOTE OPTIONS, Arizona, United States - PHOENIX, Arizona, United States

State of Arizona

Job Description
Claims Adjudication Specialist - REMOTE OPTIONS, Arizona, United States - PHOENIX, Arizona, United States + Home + Current Openings ( + Benefits + Applicant Login ( Kiosk mode Apply Now First Name (required) 629982d5 Last Name (required) c5e5695a Email (required) 5fb356f5 Apply Please wait... Done Not You? Thank you Claims Adjudication Specialist + 509299 + PHOENIX + REMOTE OPTIONS + AHCCCS + Full-time AHCCCS Arizona Health Care Cost Containment System Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork The Arizona Health Care Cost Containment System (AHCCCS), Arizona's Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. Come join our dynamic and dedicated team. Claims Adjudication Specialist Division of Fee for Service Management Job Location: Address: 801 E Jefferson St, Phoenix, AZ 85034 Posting Details: Open until filled Salary: $30,800 - $32,655 Grade: 15 This position is eligible for part-time/full-time remote work (including virtual office arrangement). Must reside in the State of Arizona. Job Summary: The Division of Fee for Service Management (DFSM) is looking for a highly motivated individual to join our team as a Claims Adjudication Specialist. This position is responsible for processing claims that are pended and have to be adjudicated per agency policies and procedures. This position has the potential to work from a Virtual Office (VO) setting or may telecommute based on the needs of the unit and at the discretion of leadership. Major duties and responsibilities include but are not limited to: Adjudicates pended claims, request medical documentation from providers, checks Docuware & Prepaid Medical Management Information Systems (PMMIS) for consent forms, eligibility of benefits (EOBs) and Third-Party Liability, reviews the history for duplicate claims/payments, identifies inappropriate billing patterns and forwards to appropriate unit, ensures medical documentation is included with submissions, supplements and links documentation, recoups and voids claims. Ensure the system is appropriately processing claims, identifies problems/issues and notifies appropriate parties for resolution, identifies inappropriate billing patterns which are then reported to the Audit Unit or to the Agency's Fraud Unit for review. Verifies eligibility of claims, using Agency's policies and procedures, coordinates claims that have Third Party Liability. Other duties as assigned as related to the position. Knowledge, Skills & Abilities (KSAs): Knowledge: Thorough knowledge of all aspects of claims processing. Knowledge of medical terminology, CPT codes, ICD-10 codes, HCPCS codes and CDT codes. Abilities: Ability to maintain a pre-determined production level and to multitask in a fast-paced environment. Skills: Intermediate computer skills. Verbal and written communication skills with staff. Qualifications: Minimum: One (1) year experience in insurance processing. Preferred: Experience working in adjudication and working knowledge of medical coding Pre-Employment Requirements: Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees. Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency's ability to reasonably accommodate any restrictions. Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed. Benefits: Among the many benefits of a career with the State of Arizona, there are: 10 paid holidays per year Paid Vacation and Sick time off (12 and 13 days per year respectively) - start earning it your 1st day (prorated for part-time employees) A top-ranked retirement program with lifetime pension benefits A robust and affordable insurance plan, including medical, dental, life, and disability insurance Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications) RideShare and Public Transit Subsidy A variety of learning and career development opportunities Opportunity to work 100% virtually or remotely on an ad-hoc basis (home office) By providing the option of a full-time or part-time virtual/remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion. For a complete list of benefits provided by The State of Arizona, please visit our benefits page ( Retirement: Lifetime Pension Benefit Program Administered through the Arizona State Retirement System (ASRS) Defined benefit plan that provides for life-long income upon retirement. Required participation for Long-Term Disability (LTD) and ASRS Retirement plan. Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period). Deferred Retirement Compensation Program Voluntary participation. Program administered through Nationwide. Tax-deferred retirement investments through payroll deductions. Contact Us: Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer. Search by job title, location, department, category, etc. Search Jobs Near Me ARIZONA MANAGEMENT SYSTEM (AMS) All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress. Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results. State employees are highly engaged, collaborative and embrace a culture of public service. The State of Arizona is an Equal Employment Opportunity Employer.