Direct Bill Processor Jobs in Arizona (NOW HIRING)

Summary

Performs a variety of complex billing and accounting functions. Review and process rejected claims, verify and work adjudicated claims, resolve and resubmit claims compliant with reimbursement eligibility. Ensure payments and denials are made in accordance with payer contracts and company procedures. Review of invoice information, maintain third-party billing records, and resolve variety of claims and contract issues.

Essential Duties and Responsibilities (Billing Processor I, II and CPC):

• Verifies member coverage, benefits and services allowed for Medicare, Commercial and AHCCCS payors.
• Confirms health insurance coverage for coordination of benefits to process claims
• Works with payors to request and resolve Prior Authorizations discrepancies.
• Resolves rejected and denied billing errors.
• Applies provider contract provisions to determine if claim is payable or denied.
• Determines if denied claims related to rendering provider, service location, coordination of benefits, refunds or adjustments.
• Reviews medical and behavioral claims, post payment or denial codes within established department guidelines and standards
• Maintain records, files, and documentation as appropriate
• Maintains billing, explanation of benefits, and Receipts filing system and records retention.
• Runs denials and cash receipts reports.
• Posts receipts and Explanation of Benefits (EOB) via manual posting.
• Routinely monitors and ensures eligibility segments are documented correctly in NextGen.
• Meet department production and quality standards
• Performs other related duties in accordance with agency growth and changes.

Additional Essential Duties and Responsibilities for Billing Processor II

• Reviews and processes inbound 835 electronic response files (ERAs) for the assigned Medicaid payer.
• Reviews and resolves claim discrepancies and errors prior to posting the assigned Medicaid ERA.
• Responsible to communicate and resolve any posting errors with NextGen directly.
• Assigns denied and rejected billing claims to their Medicaid team members.
• Prepares and reports payor payment trends for the assigned Medicaid payer.
• Point of contact for communicating directly with the Medicaid provider representative.
• Point person to communicate and resolve denials and rejections for the assigned Medicaid payer.
• Reconciles Medicaid payer monthly payments to EFTs and communicates discrepancies to the supervisor.
• Assists billing team members with denied and pended billing errors.
• Assists with training specific to the assigned Medicaid payer.

Additional Essential Duties and Responsibilities if Certified Professional Coder

• Answer calls and emails related to coding.
• Review denial notes to determine correctness in diagnosis, modifier & CPT code
• Assist providers in selecting correct CPT codes
• Assist Data Validation Audits

Skills & Requirements

Education:

• Associates degree in related field preferred; additional experience may substitute for a degree.

Experience:

• Billing Processor I –

• 3 years billing & claims processing experience

• Billing Processor II -

• A minimum of 5 years billing & claims experience AND;
• A minimum of 1 year processing claims as assigned to the primary Medicaid ERA funder

• Certified Professional Coder

• Active AAPC Certification

Other:

• Bilingual skills a plus.
• Use of Microsoft Office programs Word, Excel, and Outlook.

Pay Information:

• Pay Comments: Pay rate based on level of education, certification and years of work experience relevant to this position.

"Equal Opportunity Employer Minorities/Women/Veterans/Disabled"

Why Choose CODAC!

Whether it’s providing direct member care or offering professional, technical, clerical or other expertise and support, staff at CODAC are integral to the wellbeing of our members and to the success of our organization.

CODAC offers a culturally diverse, customer-service oriented workplace that you can be proud of. You can have a rewarding professional career and an excellent quality of life working at CODAC.

At CODAC, we focus on the needs of people - the people we serve and the people who serve with us. That’s why we’re proud to offer an impressive array of benefit options to meet the needs of your unique lifestyle.