Job Description

PHOENIX 27,000.00-31,000.00

Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork

Claims Customer Service Representative

First resume review: 09/18/2020

Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid Agency, is driven by the passion to deliver comprehensive and cost effective health care to Arizonans in need. AHCCCS is nationally acclaimed as a model for other Medicaid programs and recipient of multiple awards for excellence in workplace effectiveness and flexibility.

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. Visit our careers page to learn more about AHCCCS. Use your skills to benefit others; join the AHCCCS Team!

The Division of Fee for Service Management (DFSM) is looking for a highly motivated individual to join our team as a Claims Customer Service Representative. The position operates with a call center environment, answering phone calls from AHCCCS Providers regarding the status of medical claims submitted, identifying errors and advising the Provider on the resubmission of the claims process. Major duties and responsibilities include but are not limited to:

* In a call center environment, provides technical assistance to providers and agency staff regarding billing procedures, reimbursement policies, prior authorization requirements and eligibility information.

* Researches provider claims and prior authorization inquiries to provide status and identify billing, procedure or processing problems. Refers to appropriate areas for additional claims research if needed.

* Collects documentation for resubmission of claims and prior authorizations. Assures quality of claims in each of the claims processes.

* Prepares documentation for research and coordinates resolution of provider issues between various claim departments.

* The ability to elevate a situation/issue to a higher level.

* The ability to multi-task in a fast paced environment.

* Excellent verbal and written communication skills.

* Intermediate computer skills (i.e. Microsoft Office Suite, Word, Excel, Outlook, and Google.

* General knowledge of all AHCCCS and Fee for Service Programs.

* Minimum of 1 year experience in medical claims processing.

* Minimum of 1 year medical claims customer service.

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. Click here to learn more about benefits.

Arizona State Government is an EOE/ADA Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by calling (602) 417-4497. Requests should be made as early as possible to allow sufficient time to arrange the accommodation. AHCCCS is an Equal Employment Opportunity Employer. All newly hired employees will be subject to E-Verify Employment Eligibility Verification.

Click the APPLY NOW button to submit your application.
For technical assistance, email or call 602-542-4700.

Application Instructions

Please apply for this position by following the link provided below. A new window will open on your screen and you will be directed to the Arizona Health Care Cost Containment System (AHCCCS) employment website.

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