Claims Coordinator

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 12 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost. The Claims Coordinator is a multi-faceted position, that will be responsible for supporting various areas of the Claims Department. As detailed below, primary responsibilities of the Claims Coordinator will include: documenting, analyzing and transmitting all medical documents received to the appropriate departments; assisting with inbound provider phone calls; respond to emails from internal departments regarding claims issues while collaborating with the claims examiners to resolve issues, and communicate resolutions to providers and/or internal departments. POSITION DUTIES & RESPONSIBILITES Review and analyze claims in AZPC’s processing system (EZ-CAP) for appropriate Prior Authorization’s and/or Case Management ID’s for processing of claims Working data integrity reports Communicate with providers in a courteous and timely manner Prepare medical records for scanning and routing to the appropriate department(s) Scan medical records into the document management system Analyze claims to determine if medical records are required for processing Review medical records for verification of contracted or non-contracted ordering and/or referring providers Provide follow-up on outstanding review requests Process denied claims based on reviewer determinations, or route to examiners as appropriate Perform other document control and management activities as assigned including but not limited to, opening and sorting mail and data entry of claims Identify and communicate process improvement opportunities to management team Perform eligibility validation inquiries and documentation with a high degree of speed and accuracy Handles incoming calls, inquiries or concerns in a positive and helpful manner, seeking resolution and follow-up within 24 hours Process daily incoming documents received via mail and fax Responding to Provider inquiries in a timely and professional manner Perform claim data integrity validation checks Follow established policies, formats, procedures and timelines to complete assigned tasks Perform other duties as assigned EDUCATION, TRAINING AND EXPERIENCE High school diploma or equivalent (GED) Minimum 1 year of medical claims processing experience required Strong experience and knowledge of Claims, Medicare/Medicaid guidelines, ICD-9, HCPCS / CPT coding, HCFA 1500’s & UB04’s Prior experience in customer service preferred Knowledge of healthcare terminology Knowledge of various medical claim forms i.e., Professional and Facility Strong computer skills including touch typing and experience with Microsoft applications (Word, Excel, Outlook) Must be able to read and interpret documents such as processing and procedure manuals, medical terminology and claims rules and regulations to appropriately develop the claim Demonstrate personal initiative, team spirit and service orientation while maintaining a positive, caring and professional attitude. Strong organizational skills and the ability to work independently and under pressure on time-sensitive materials Interacts and communicates effectively Excellent time management skills Strong attention to detail Must be able to work under guidance of Team Lead *This role requires FT in-office presence for the first 60 days of employment. Hybrid schedule available after initial training period.* #J-18808-Ljbffr