CLAIMS PROCESSOR - MEDICAID (HYBRID)

Company: Blue Cross Blue Shield of Arizona
Location: Phoenix
Posted on: September 30, 2024

Job Description:

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

This position requires work and residency in the state of Arizona.

Blue Cross Blue Shield of Arizona (BCBSAZ) is immediately hiring a full-time Claims Processor to help inspire a healthier Arizona. As our Claims Processor, you will come alongside our Reimbursement Services department to adjudicate incoming claims in accordance with policies, procedures, guidelines, regulatory requirements, and contractual agreements.

As you do, you'll thrive in an energetic, diverse environment, championed by an organization consistently named a Best Places to Work and Most Admired Company in Arizona.

Inspiring Health in Arizona Starts with You

Our benefits support work-life balance and the flexibility you need to be your best.

They include:

• Eleven (11) paid holidays, including a floating holiday you can use any time you wish
• Accrued paid time off (up to 18 days per calendar year)
• Comprehensive medical, dental, and vision coverage
• 401(k) up to 5% dollar-per-dollar match, 2% non-elective employer contribution
• Eight (8) paid volunteer hours to support our mission of inspiring health
  • Tuition reimbursement for you; scholarship opportunities for your children
  • Employee discounts, gym reimbursement, and wellness programs
  • Treadmill desks, full-service fitness center, onsite cafeterias
  • Ongoing training for employees who wish to grow in their careers, acquire skills, and become managers
    
    To thrive in this job, you must be able to:
    • Maintain confidentiality and privacy
      • Compose and dictate a variety of business correspondence
      • Interpret and translate policies, procedures, programs, and guidelines
      • Perform investigative and analytical research
      • Maintain production and quality standards to help ensure claims are processed correctly the first time
      • Navigate, gather, input, and maintain data records in multiple system applications
      • Follow and accept instruction and direction
      • Establish and maintain working relationships in a collaborative team environment
        
        Responsibilities
        • Adjudicate claims according to regulatory, contractual and health plan requirements
        • Pre-screen accuracy of EDI submissions through review of data elements in claims system
        • Verify a claim is not a duplicate of a previously submitted claim
        • Keep updated with processing manual and other educational/training materials
        • Know and adjudicate claims according to COB provisions
        • Identify and refer TPL issues to appropriate department
        • Identify and refer medical review claims to appropriate department
        • Identify and refer potential FWA claims to appropriate department
        • Identify opportunities for provider education
        • Identify opportunities for process improvement, including auto adjudication Qualifications
          • High school diploma or GED (required)
          • Associate degree in a general field of study (preferred)
          • At least one year of prior work experience
          • Experience with claims processing, including UB, 1500, and dental
          • BPT/HCPC and ICD10 coding skills
          • Knowledge of Medicaid and Medicare
            • Intermediate PC proficiency, including the ability to type at least 30 words per minute with 95% accuracy
              
              Why Join Blue Cross Blue Shield of Arizona?
              
              At BCBSAZ, your pursuit of balance, happiness, and fulfillment is supported through our Workability model. Workability is our workforce strategy and defines where and how we do our jobs.
              
              Our award-winning healthy campus in Phoenix is always available to you. Access telehealth services at our BlueCare Anywhere kiosk, fuel up with healthy meals and snacks at our Work Perks Caf--, and make the most of our onsite fitness center by taking advantage of personal trainers, a nutritionist, Health Support programs, and daily group fitness classes, including spin, yoga, and Zumba.
              
              Our Commitment
              
              AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
              
              Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

Keywords: Blue Cross Blue Shield of Arizona, Phoenix , CLAIMS PROCESSOR - MEDICAID (HYBRID), Other , Phoenix, Arizona