Claims Specialist

US-AZ-Phoenix
Job ID
2017-2577
# Positions
1
Category
Administrative/Clerical

Overview

Under the supervision of the Claims Manager, this position will process claims and billing statements for the agency, provide all necessary follow-up on outstanding claims and statements, post all third-party payments and client payments from statements, post all claim denials and research and follow-up to resolve denied claims, research and follow-up on client questions regarding statements, update the billing system with changes to insurance information and notes regarding progress on researching and resolving denied claims, and provide all necessary financial reports for Accounting Department.

Responsibilities

 

  • Processes all AHCCCS, RBHA, Medicare, commercial insurance and ALTCS claims following required procedures; provide all necessary follow-up including collections on outstanding claims.
  • Processes all client statements, researches and follows up on client questions regarding statements.
  • Posts all third-party payments, denials and adjustments; posts client payments resulting from statements.
  • Researches and follows up to resolve denied claims, makes notes in the billing system to document the progress of denied claim follow-up efforts.
  • Updates the billing system with changes to client insurance information and enters necessary alerts for the Operations staff on changes to insurance information and/or co-pay status of clients.
  • Prepares all necessary financial reports and information for accounting department and CFO/COO.
  • Communicates and coordinates effectively with internal and external contacts in a professional and timely manner to resolve billing and claims issues.
  • Participates in Quality Improvement efforts.

 

 

Qualifications

High school education or equivalent; billing and/or collections experience highly desirable.  Must be able to receive/maintain license and DPS fingerprint clearance.

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