Job: CLAIMS SPECIALIST 2(Job Id 33463)

This posting has expired and is no longer available.

Job Description

10/12/2017 10/19/2017
ADMINISTRATIVE 15
PHOENIX 30,492.00-35,152.00

Department of Economic Security

Providing Opportunity, Assistance and Care for Arizonans in need!

Claims Specialist 2

Division of Developmental Disabilities

1789 W. Jefferson St.,

Phoenix, AZ 85007

www.azdes.gov

JOB SUMMARY:

This position will provide excellent communication skills to a high volume of customers that reflect the complexity of reviewing Explanation of Benefits and waivers to meet the Coordination of Benefits requirement.

JOB DUTIES: 

-          Monitors system automated approved or denied claims in accordance with Division and Arizona Health Care Cost Containment system (AHCCCS) rules and regulations to ensure proper claims adjudication and audit compliance.

-          Work claim adjustments as they pertain to encounters and reconciliations.

-          Determine approval or denial of waiver request, process claims for title XIX members.

-          Reports member insurance benefits not identified at time of claim submission to AHCCCS.

-          Researches denied lines for appropriate resolution, answer telephone calls regarding questions on routine claims.

-          Complete special projects as assigned by manager.

 

KNOWLEDGE, SKILLS AND ABILITIES (KSAs):

Knowledge of:

-          Principles and practices of accounting and basic math

-          Federal and state laws, AHCCCS rules and regulations as applied to processing medical claims

-          Diagnostic and procedural coding used on medical claims

-          Computerized products used in accounting systems and processes

Skill in:

-          Providing excellent Customer Service

-          Oral and written communication

-          Researching, analyzing, and problem solving to determine accurate course of action for claims processing

-          Active listening and attention to detail

-          Developing long range planning for cyclic events and seasonal variations in workload demands

-          Interpersonal relations

Ability to:

-          Analyze billing problems and recommend usable solutions

-          Diffuse and resolve complicated issues while maintaining professional relationships

-          Provide training to mixed groups of individuals with diverse backgrounds

-          Cross-train to other duties within the unit

-          Work as a contributing member of a cohesive work-group

-          Read and interpret Explanation of Benefits to determine clean claim status on the adjudication of a claim

SELECTIVE PREFERENCE(S):

-          The preferred/ideal candidate will have experience with medical claims processing, third party liability and/or Coordination of Benefits

-          In-state travel is required

PRE-EMPLOYMENT REQUIREMENTS: 

-          Valid Professional License

BENEFITS: 

 The Department of Economic Security offers a comprehensive benefits package to include: 

-          Sick leave

-          Vacation with 10 paid holidays per year

-          Health and dental insurance

-          Retirement plan

-          Life insurance and long-term disability insurance

-          Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance

RETIREMENT: 

Positions in this classification participate in the Arizona State Retirement System (ASRS). 

Please note, enrollment eligibility will become effective after 27 weeks of employment.

CONTACT US: 

If you have any questions please feel free to contact Kimberly Smith at [email protected] and 602-542-0080 for assistance.

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting INSERT CONTACT NAME AND CONTACT INFO HERE. 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.