Claims Processor – Medical Review Nurse

Job Title: Claims Processor - Medical Review Nurse

Posting Title: Phoenix, AZ - Medical - Healthcare - AHCCCS - Division of Fee for Service Management (DFSM)

Position Overview:

We are seeking a dedicated and detail-oriented Medical Review Nurse to join our team at the Arizona Health Care Cost Containment System (AHCCCS) within the Division of Fee for Service Management (DFSM). The Claims Processor will assist in the review and processing of medical claims, ensuring accurate and timely adjudication of healthcare services for AHCCCS members. This is a remote position, offering flexibility while contributing to the important work of managing healthcare services for the Arizona community.

Posting Information:

• Location: Remote (Primary office in Phoenix, AZ)
• Department: AHCCCS - Division of Fee for Service Management (DFSM)
• Position Type: Staff Augmentation
• Hours/Week: 40 hours
• Shift: Day
• Projected Start Date: 04/14/2025
• Projected End Date/Duration: At least 3 months from the projected start date
• Start Time: 8:00 AM
• End Time: 5:00 PM
• Number of Positions: 7
• Job Posting Status: Active
• Closing Date & Time: 04/09/2025, 3:00 PM (GMT-7:00 Arizona)
  
  

Position Requirements:

• Education: Minimum High School Diploma or equivalent.
• Experience: Entry-level experience is preferred. Previous experience in medical claims processing or healthcare settings is a plus.
• Skills & Certifications:
• Knowledge of medical terminology, healthcare processes, and claims management.
• Experience in reviewing medical claims for compliance with established guidelines.
• Strong attention to detail and ability to work independently.
  
  

Responsibilities:

• Review and process medical claims for services rendered to AHCCCS members.
• Verify medical documentation, ensuring all claims meet requirements for approval.
• Communicate with healthcare providers and team members to resolve issues with claims.
• Document and report any discrepancies or issues found during the claims review process.
• Ensure compliance with all applicable healthcare policies, regulations, and procedures.
• Support the accurate and efficient handling of healthcare claims in accordance with AHCCCS guidelines.
• Work collaboratively with other departments to improve the accuracy and efficiency of claims processing.
  
  

Desired Career Level:

Entry Level

Compensation:

• Current Low Bid: $44.05/hour
• Billing Type: Hourly
  
  

Location:

• Office Address: 801 E Jefferson St., Phoenix, AZ 85034, United States
  
  

Security Requirements:

This position requires security clearance.

Travel:

No travel required for this position.