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Claims Processor

Tempe, AZ · Healthcare
Medical Claims Processor – Managed Care
Tempe, AZ
** This is a Full Time, Benefits Available, CONTRACT-TO-HIRE opportunity, expected to last several months before converting into a Permanent position! ** 
Claims Processor Job Summary:
  • Process claims for medical necessity, coding and assure payment per the terms of the contract, member benefits and authorization.
  • Research and resolve complex verbal and written providers’ claims inquiries
  • Provide technical review of claims and medical records including records submitted by providers and internal records provided in electronic healthcare data bases.
  • Identify providers experiencing a large number of claims issues or with the potential to develop claims issues and proactively work to eliminate barriers for accurate and timely claims processing.
  • Direct and educate provider services and provider relations staff with the claims reprocessing notification, utilizing knowledge of provider billing and claims processing.
  • Identify needs and conduct additional claims training to internal departments.
  • Apply knowledge of medical bill analysis relating to state and federal regulations affecting medical billing practice.
  • Review claims to identify any potential third party or workers’ compensation liability and inform management.
  • Communicate with appropriate internal staff when identifying questionable billing practices or third party collection opportunities.
Claims Processor Background Profile:
  • Requires graduate of high school or equivalent education; Associate degree preferred.
  • At least 1-2 years direct experience as a claims processor / claims reviewer /physician biller required; will consider other healthcare support experience.
  • Working knowledge of ICD-9, CPT, HCPCs, revenue codes, and medical terminology preferred.
  • Experience with Medicaid or Medicare claims preferred.
  • Strong analytical mind, with problem solving skills, an aptitude for accuracy, and attention to detail.
  • Ability to interpret, analyze and summarize large data sets and develop reports.
  • Basic computer skills required, to include Microsoft Office, healthcare software, and data entry.
623.201.8732 (CALL – TEXT – FAX)
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