What are the responsibilities and job description for the Medical Claims Specialist position at The Temp Connection?
Claims Specialist
Hours of work - M-F - 8-5 p.m.
Pay $20-23 per hour
Must have DPS Level I fingerprint clearance to be considered.
Job Summary :
Responsible for preforming all levels of claims processing and review.
Job Responsibilities :
Prepares all claims for billing, ensuring all claims are valid and authorized per the contracts. Includes running pre-billing reports to review for accuracy and running non-billable services report to ensure all billing is captured. Non-billable service reports should be communicated to Program Directors.
Claims submission to Commercial plans, AHCCCS and Regional Behavioral Health Authority (RBHA), both contracted and non-contracted, for final resolution.
Ensures accurate and timely filing.
Reprocessing of denied claims with follow up to paid resolution / adjustment
Recognizing and reporting trends
Validates NPI / Tax ID
Validates payor ID
Departmental goal is to be under 120 days for file rejections and denied claims
Works with EHR systems and Internal Departments
COB / TLP claims processing
Appeals and Grievances
Self-pay plan review / billing
Payment posting
Ensures claim files are submitted accordingly. Submission should not exceed 30 days from initial service date or 60 days for claim rejections and / or denials
Produces reports for internal and external customers and assists in the preparation of presentations for upper management and providers
Attends meetings related to the claims system
Completes required trainings
Maintains current knowledge of Billing Rules and Guidelines.
Create and maintain timely guidelines for all payers
Knowledge of CPT, ICD-10, HCPC codes / coding
All other duties as deemed necessary
Maintains an approved schedule and acceptable level of attendance. QUALIFICATIONS :
Education - HS / GED
Certification - Certified Professional Coder or AAPC / AMA Certification preferred
Experience -
5 years claims processing experience preferred.
Behavioral Health billing experience preferred.
REQUIRED :
21 years of age
Current, valid Arizona Driver's License, 39-month Motor Vehicle Report and proof of vehicle registration and liability coverage to meet insurance requirements.
Must have DPS Level I fingerprint clearance card
First Aide, CPR certification (Employer provides)
Initial current negative TB test result, within the prior 12 months. (Employer provides)
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