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Skills: Medical Claims Processing, Coordination Of Benefits, Third Party Liability, Reinsurance, Medical Coding
Phoenix, Arizona, United States · On-site
$97k–$155k/yr
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Phoenix, Arizona, United States · Remote OK
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ARIZONA STATE SCHOOLS FOR THE DEAF AND THE BLIND ASDB serves over 2,000 children who are blind, visually impaired, deaf, hard of hearing or deafblind from birth to grade 12 Executive Assistant to the Board Job Location: …
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Phoenix, Arizona, United States · On-site
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Phoenix, Arizona, United States · On-site
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Phoenix, Arizona, United States · On-site
$47k–$50k/yr
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Phoenix, Arizona, United States · On-site
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Phoenix, Arizona, United States · Hybrid
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Phoenix, Arizona, United States · On-site
Community Bridges, Inc. (CBI) is an integrated behavioral healthcare agency offering a variety of different programs throughout Arizona. CBI provides residential, outpatient, inpatient, patient-centered medical homes, me…
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Phoenix, Arizona, United States · Hybrid
SQL Server Database Administrator / SSRS Developer | Phoenix Hybrid | $75/hr W2 | 2-Year Arizona Contract Location: Phoenix, AZ 85003 - Hybrid (approx. 75% onsite, 25% remote) Pay Rate: $75/hr W2 (1099 option available) …
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Phoenix, Arizona, United States · On-site
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Phoenix, Arizona, United States · On-site
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Phoenix, Arizona, United States · On-site
$75k–$117k/yr
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Skills: Transportation Planning, Project Management, Stakeholder Coordination, Technical Writing, GIS
Phoenix, Arizona, United States · Hybrid
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Phoenix, Arizona, United States · On-site
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Phoenix, Arizona, United States • On-site
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Manually process Coordination of Benefits Waivers and validate Third Party Liability verifications for complex medical claims. Handle specialty reinsurance requests and compile documentation for reporting and standard operating procedure updates.
Requires knowledge of accounting principles, AHCCCS rules, and medical coding terminology. The ideal candidate has experience with TPL, reinsurance, and medical claims processing.
DEPARTMENT OF ECONOMIC SECURITYYour Partner For A Stronger Arizona.
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| Job Location: |
| Posting Details: |
| Job Summary: |
Would you like to be part of an amazing team that helps Arizonans thrive? At the Department of Economic Security (DES), we strengthen individuals, families, and communities for a better quality of life. DES is looking for individuals that are committed to service, community, and teamwork. To learn more about DES please visit des.az.gov; or click on the link here to view ‘Our DES’ video. Come join the DES Team!
The Department of Economic Security, Division of Developmental Disabilities (DDD), is seeking an experienced and highly motivated individual to join our team as a Program Project Specialist 1. DDD provides individuals with developmental disabilities, and their families, services and supports that are flexible, high quality, and member driven. These services provide individuals with opportunities to exercise their rights and responsibilities of independent decision-making and engagement in the community.
Applicants for this position cannot be licensed or certified by the DDD Office of Licensing Certification and Regulation, cannot have a principal interest in or have a spouse or close family with principal interest in a DDD Qualified Vendor Agreement, and cannot be employed or subcontracted by a DDD Qualified Vendor.
| Job Duties: |
Essential Duties and Responsibilities include but are not limited to:
• Manually process Coordination Of Benefits Waiver (COBW) request for complex medical claims. Analyze and research individual requests with unique coordination of benefit documentation provided by the TPL carrier. Determine if documentation is sufficient or if additional documentation is necessary. If necessary, direct contact to TPL(s) for verification prior to making informed decisions. Meet Deliverable timeliness requirements.
• Manually review and validate TPL verifications for eligibility using multiple sources including but not limited to varied databases, IVR, and verbal confirmations. Document, add or amend multiple databases, as necessary while maintaining Deliverable timeliness requirements. Review and respond to provider inquiries.
• Process and document complex reinsurance requests for all specialty reinsurance lines (including but not limited to Reinsurance, Catastrophic Reinsurance, Biologic, Hemophilia, and Transplants). Prepare documentation for other units (including but not limited to Finance, Medical Management, and MIS). Maintain timeliness for AHCCCS Deliverables. Work closely with sub-contracted acute plans to ensure they process encounters timely for reimbursement.
• Compile documentation to generate reports. Updates standard operating procedures. Attends trainings and meetings. Assists with special projects, as necessary.
| Knowledge, Skills & Abilities (KSAs): |
Knowledge in:
• Principles and practices of accounting.
• Federal and State laws, AHCCCS rules and regulations as applied to processing medical claims.
• Diagnostic, procedural coding and terminology used on medical claims.
• Computerized products used in accounting systems and processes; Case management principles as applied to development of individuals with disabilities .
• Complex math; Understanding of Reinsurance, Coordination of Benefits, Third Party Liability, and Medical Claims .
Skills in:
• Professional and comprehensive oral and written communication.
• Excellent Customer Services; Critical thinking ; Problem solving .
• Analytical analysis and research for independent decision making.
• Auditing ; Organizational skills for utilizing multiple resources to complete tasks.
• Moderate computer skills in Google Suites as well as multiple databases used by the Division.
• General computer skills such as typing and ten key; Interpersonal relationships.
Ability to:
• Analyze various often complex insurance documentation; Ability to work in multiple systems to complete tasks.
• Analyze billing problems and recommend viable solutions; Understanding customer needs; Identifying problems .
• Diffuse and resolve complicated issues while maintaining professional relationships.
• Provide training to diverse backgrounds; Analyze and evaluate data in order to assign to proper routes.
• Learn, interpret and apply Federal and State laws rules and regulations as they pertain to the assigned programs in the Division.
• Learn multiple processing systems; Measure results, meet productivity and quality standards.
| Selective Preference(s): |
The ideal candidate for this position will have:
• Experience with medical claims processing, TPL, coordination of benefits, reinsurance, and medical coding.
| Pre-Employment Requirements: |
• If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements. Any employee operating a motor vehicle on State business must possess and retain a current, valid class-appropriate driver's license, complete all required training, and successfully pass all necessary driver's license record checks. The license must be current, unexpired, and neither revoked nor suspended. Employees who drive on state business are subject to Driver's license record checks, must maintain acceptable driving records, and must complete all required driver training. An employee who operated a personally owned vehicle on state business shall maintain the statutorily required liability insurance (see Arizona Administrative Code (A.A.C.) (R2-10-201.11).
• Successfully pass background and reference check; employment is contingent upon completion of the above-mentioned process and the Agency's ability to reasonably accommodate any restrictions.
• All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).
| Benefits: |
The Arizona Department of Economic Security offers a comprehensive benefits package to include:
• Affordable medical, dental, life, and short-term disability insurance plans
• Participation in the Arizona State Retirement System (ASRS) and long-term disability plans
• 10 paid holidays per year
• Paid vacation and sick time
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child.
• Deferred compensation plan
• Wellness plans
• Tuition Reimbursement
• Stipend Opportunities
• Infant at Work Program
• Rideshare and Public Transit Subsidy
• Career Advancement & Employee Development Opportunities
Learn more about the Paid Parental Leave program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page
| Retirement: |
State employees are required to participate in the Arizona State Retirement System (ASRS), the State sponsored retirement contribution plan and the Long-Term Disability (LTD) program after a 27-week waiting period. The ASRS defined benefit plan provides for life-long income upon retirement. You will also have the option to participate in a voluntary deferred compensation program to take advantage of tax-deferred retirement investments.
On, or shortly after, your first day of work you will be provided with additional information about the available insurance plans, enrollment instructions, submission deadlines and effective dates.
| Contact Us: |
For questions about this career opportunity, please contact Shobana Jeyaraj at 480-915-7157 or [email protected].
The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 480-915-7157 or [email protected]. Requests should be made as early as possible to allow time to arrange the accommodation.
Connecting Arizona: Everyone, Everywhere, Every Day.
Our Mission: We provide highway infrastructure and transportation services. Our Vision: To safely connect people and empower our economy. Our Values: Easy to work with, collaborative, results focused. Transportation touches everyone who lives, works and plays in our state. ADOT employees have a role in providing Arizona with a superior transportation system that meets today's needs and tomorrow's challenges. ADOT embraces a culture in which every employee has the opportunity to be a leader upholding our values of accountability, integrity and respect. Take a look through the employment opportunities we have available, and see if a career with ADOT is right for you.
Offices: 206 S. 17th Ave., Phoenix, AZ 85007, US
There are currently 330 open government & public sector positions in Phoenix, AZ listed on Clera. New openings are added daily as companies post roles.
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