• Claims Specialist

    Location US-AZ-Phoenix
    Job ID
    2018-2872
    # Positions
    1
    Category
    Administrative/Clerical
  • Overview

    The Claims Specialist processes claims and billing statements for the agency, provides all necessary follow-up on outstanding claims and statements, posts all third-party payments and client payments from statements, posts all claim denials and researches and follows-up to resolve denied claims, researches and follows-up on client questions regarding statements, updates the billing system with changes to insurance information and notes regarding progress on researching and resolving denied claims, and provides all necessary financial reports for the 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 diploma or equivalent
    • One year of billing and/or collections experience highly desirable

     

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