ZipRecruiter

Log In

1

Claims Edit Coder Jobs in Arizona (NOW HIRING)

Clopay

Customer Service Representative

Gilbert, AZ · On-site

$16 - $21.75/hr

Balance daily invoice edit. * Audit open order reports weekly. * Follow up on customers' claims for ... D. accounts, including requisitions for new customer codes. * Assist with furnish and install ...

Clopay

Customer Service Representative

Gilbert, AZ · On-site

$16 - $21.75/hr

Balance daily invoice edit. * Audit open order reports weekly. * Follow up on customers' claims for ... D. accounts, including requisitions for new customer codes. * Assist with furnish and install ...

All JobsClaims Edit Coder JobsClaims Edit Coder Jobs in Arizona

Claims Edit Coder information

What is a claims edit coder?

Claims Edit Coders are healthcare professionals who review and analyze medical claims to ensure they are coded accurately and comply with insurance and regulatory guidelines. They use specialized coding systems, such as ICD-10, CPT, and HCPCS, to verify that procedures and diagnoses are properly documented. Their work helps prevent billing errors, reduce claim denials, and ensure timely reimbursement for healthcare providers. Claims Edit Coders often collaborate with billing departments and healthcare providers to resolve discrepancies and improve coding accuracy.

What are the key skills and qualifications needed to thrive as a claims edit coder, and why are they important?

To thrive as a Claims Edit Coder, you need a solid understanding of medical coding (ICD-10, CPT, HCPCS), claims processing, and healthcare regulations, typically supported by a coding certification such as CPC or CCS. Familiarity with electronic health record (EHR) systems, claims editing software, and payer-specific coding guidelines is crucial. Attention to detail, analytical thinking, and effective communication are vital soft skills for accurately identifying and resolving coding errors. These skills ensure correct claim submission, minimize denials, and support timely reimbursement for healthcare providers.

What are some common challenges faced by a claims edit coder, and how can they be addressed?

Claims Edit Coders often encounter challenges such as staying updated with frequent changes in coding regulations and payer-specific requirements. Additionally, coding errors or discrepancies may arise due to incomplete or unclear documentation from providers. To address these issues, it's important to engage in ongoing education, actively communicate with clinical staff for clarification, and utilize reliable coding resources and software. Collaboration with team members and regular training can help maintain accuracy and compliance in claim submissions.

What is the difference between Claims Edit Coder vs Claims Processing Specialist?

AspectClaims Edit CoderClaims Processing Specialist
CertificationsCertified Coding Associate (CCA), CPCNone required, but certifications can be beneficial
Work EnvironmentHealthcare facilities, insurance companies, remoteInsurance companies, healthcare providers, office setting
Primary ResponsibilitiesReview and correct claim data, ensure coding accuracyProcess claims from submission to payment, handle inquiries

Claims Edit Coders focus on reviewing and correcting claim data to ensure accurate coding, while Claims Processing Specialists handle the overall processing of claims from submission to resolution. Both roles require knowledge of insurance policies and coding, but Claims Edit Coders are more specialized in coding accuracy, whereas Claims Processing Specialists manage broader claim workflows.

What are popular job titles related to Claims Edit Coder jobs in Arizona?

For Claims Edit Coder jobs in Arizona, the most frequently searched job titles are:

What job categories do people searching Claims Edit Coder jobs in Arizona look for?

The top searched job categories for Claims Edit Coder jobs in Arizona are:

What cities in Arizona are hiring for Claims Edit Coder jobs?

Cities in Arizona with the most Claims Edit Coder job openings:

Claims Edit Coder jobs near you

Provider Data Specialist

Arizona Priority Care

Chandler, AZ

Full-time

Posted 5 days ago

Job description

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 14 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 Provider Data Specialist is responsible for the entry and maintenance of provider and vendor data in EzCap.

  1. POSITION DUTIES & RESPONSIBILITIES
  • Ensure that all required data such as NPI, License, primary specialty taxonomy code, OIG LEIE, certifications and accreditations are researched and recorded in the appropriate fields of the provider record.
  • Ensure that the provider data entered meets the format standards set by AZPC.
  • Run reports to identify providers and vendors records that do not meet the established data or format requirements.
  • Run SQL queries in EzCap to identify claims requiring provider or vendors additions.
  • Update provider contract status information upon receiving notice of contract effective date or contract termination date.
  • Run reports to identify claim errors that require provider data update for error resolution, including by not limited to Providers Health Plan Panel is not in effect on Service Date or Provider Contract Not in Effect on Date of Service.
  • Maintain knowledge and understanding of contracts, Division of Financial Responsibility (DOFR), Network Areas and coverage area.
  • Update vendor remittance addresses as required. Document the source of the updated information in the vendor notes. Valid sources include notification from the provider, forwarding orders received from the USPS and forwarding address information received from RedCard.
  • Note the receipt of a W9 in the vendor notes. Compare Business Name, mailing address and SSN/EIN information on the W9 with the information entered in EzCap. Make changes if required in EzCap and have the W9 scanned to Document Management.
  • Run reports and add/edit data in a timely manner.
  • Other duties and projects as assigned.
  1. EDUCATION, TRAINING AND EXPERIENCE
  • High school diploma or equivalent (GED)
  • Minimum 1 year of experience using EzCap, ExCel and Crystal Reports
  • Minimum 1 year experience processing claims
  • Minimum 1 year experience in the medical or health related field
  • Knowledge of Medicare rules, medical terminology, and managed care health plan rules and regulations, contracts, DOFR's, ICD-9, CPT and RVS codes.
  • Must be proficient in typing and detail oriented
  • Ability to work independently and under pressure

Ability to interact effectively with patients and professionals