Job Description

Claims Adjudicator

  • 492765
  • PHOENIX
  • AHCCCS
  • Full-time

AHCCCS

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. 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. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona.

ADOC Claims Adjudicator

AHCCCS

Posting Details:

Salary: $16.83/Hourly 

Grade: 17

Job Summary:

The Division of Fee for Service Management (DFSM) is looking for a highly motivated individual to join our team as a Claims Adjudicator. The position will research and adjudicate pended claims, correct data entry errors, review and interpret rules, policies and procedures for the purpose of adjudicating claims.

Job Duties:

* Adjudicate/edit resolution of medical claims in compliance with the Department of Corrections (DOC) Contract.

* Research and analyze pending or denied reasons for specific medical claims, and produces status reports for Management.

* Track payments and produce status reports.

* Interface with DOC Staff and/or Management regarding all aspects of the Contract.

* Formulate and present recommendations to Management regarding process improvements or compliance issues related to the DOC Contract.

* Ability to effectively manage time and productivity in a virtual office environment.

Knowledge, Skills & Abilities (KSAs):

* Experience working with Medicaid and TPL insurance.

* Understanding of various edits and overrides and how they impact medical claims processing.

* Understanding and experience with ICD10, CPT, HCPC Coding, and Medical Terminology.

* Strong verbal communication, excellent phone skills and good interpersonal skills.

* Experience working in a Windows environment, i.e. specifically Excel; and 10- key by touch.

* Understanding concepts of research and analysis.

Selective Preference(s):

* Three years of experience in medical claims processing and adjudication in a Windows environment.

* Problem solving, and know when to work independently and when to elevate an issue/concern.

* Formulate recommendations for process improvement.

* Able to multi-task in a fast paced environment.

* PMMIS experience

Benefits:

At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan.

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
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.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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