Title: Claims Specialist 1
Claims Specialist 1
- REMOTE OPTIONS
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 Specialist 1
Division of Fee For Service Management
Address: 801 E. Jefferson Street, Phoenix, AZ 85034
Open until filled
This position may offer the ability to work remotely within Arizona based upon the department's needs and continual meeting of expected performance measures.
The Division of Fee For Service Management is looking for a highly motivated individual to join our team as a Claims Specialist 1. This position is responsible for transferring data to their respective formats, data entry and verifying all claim information as submitted by the provider. Making sure there are no errors to ensure timely claim processing.
Major duties and responsibilities include but are not limited to:
- Accurately input a high volume of data from multiple sources into a database, ensuring that all necessary data is being entered as submitted by the provider. Entering data by a manual process and /or correcting fields and completing missing key fields in an Optical Character Recognition (OCR) system.
- Entry and transcribing from paper formats into computer files of medical claims, form types CMS 1500s, UB04s, and ADA Dental Forms while meeting established quality and production standards.
- Functions also includes pulling up the image of the claim, verifying the documentation attached for Medicare Explanation of Benefits (EOBs), and third-party liability, verifying key fields on the claim.
- Escalates issues and/or problem claims to supervisor/manager.
- Medical terminology used on medical claims.
- Diagnostic and procedural coding used on medical claims.
- Medicare and third-party liability insurance.
- Windows and/or Optical Character Recognition (OCR) environment.
- Claims imaging
- Basic mathematics and statistical analysis
- Concepts of research.
- Computer skills: operating keyboard, ten-key calculator.
- Accuracy and speed.
- Communicate verbally and in writing.
- Work effectively as part of a team.
- Identify problem claims and elevate in a timely manner.
- Prioritize projects and have the ability to change priorities based on teams needs.
- Meet daily quota with large volume of claims with similar tasks.
- One-year experience in insurance processing.
- Experience working in adjudication and working knowledge of medical coding.
* 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.
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 (13 and 12 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
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.
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing firstname.lastname@example.org.
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.