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Last updated: 3 days ago

Quality Control Claims Audit Technician-Claims processing-Medicare/Medicaid experience required- Hybrid

Blue Cross Blue Shield of ArizonaPhoenix, AZ, United States
Full-time

Performs internal audit reviews.Ensures accurate payment for all claim types and verifies demographic information is loaded correctly in accordance with the Arizona Health Care Cost Containment Sys...Show more

Clerical Assistant

Gold Level Media LLCPhoenix, AZ, USA
Full-time
Quick Apply

As a Clerical Assistant you will assume the duty of clerical and administrative support in order to optimize workflow procedures in the office.You will assist colleagues and executives by supportin...Show more

Front Desk Representative - $17 to $20 / hour

Action Jackson PromosPhoenix, Arizona
Full-time
Quick Apply

Job Title: Front Desk Representative.We are seeking a skilled Front Desk Representative with good experience to join our team,.Heavy data entry for all Orders,.Create item numbers with all necessar...Show more

MON44 - 4938 - Java Developer

Focused HR SolutionsPhoenix, Arizona, United States
Full-time
Quick Apply

Local to AZ Candidates only – no relocation allowed.Candidate MUST be able to attend an in-person interview in Phoenix, AZ.This position is for 6-12+ months, with option of extension, and will be w...Show more

Technician-Sterile Processing

Guardian HealthstaffPhoenix, Arizona
Full-time

Guardian HealthStaff has a 364 weeks travel contract in Phoenix, AZ.Please confirm credential requirements with Guardian HealthStaff upon application.GHS offers a customizable weekly pay package th...Show more

Merchandise Processing Associate

Savers / Value VillagePhoenix, AZ, US
Full-time +1

Job Title: Merchandise Processing Associate.As one of the largest for-profit thrift operators in the United States, Canada and Australia for value priced pre-owned clothing, accessories and househo...Show more

*Mail Processor II

Conflux Systems, Inc.Phoenix, AZ, United States
Temporary
Quick Apply

Here are the job details for your review:.Duration: 6+ Months Contract (Potential for extension).The job scope is working with the CVS corporate mailroom performing Digital printing on large produc...Show more

Document Processing & Office Support Specialist

AZ Dept. of Economic SecurityPhoenix, Arizona, United States
Full-time
Quick Apply

YOU MUST APPLY TO THE POSITION ON OUR JOB BOARD TO BE CONSIDERED: https://www.We’re looking for someone dependable and detail-oriented to join our team in a fast-paced office environment.In this ro...Show more

Sterile Processing Technician

MedPro Healthcare StaffingPhoenix, Arizona
Full-time

Joint Commission-certified staffing agency, is seeking a quality Sterile Processing Tech for a contract with one of our top healthcare clients.Sterile Processing Technician certification required.E...Show more

Mail Operations Pharmacy Technician

044 CenterWell Pharmacy, Inc.Phoenix, Arizona
Full-time

Humana”) offers competitive benefits that support whole-person well-being.Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while...Show more

Team Member - Apparel Processing (AM Shift)

ThredUPPhoenix, AZ, United States
Full-time

Team Member in Distribution Center.ThredUp is transforming resale with technology and a mission to inspire the world to think secondhand first.By making it easy to buy and sell secondhand, ThredUp ...Show more

Mailroom Account Associate

KBRPhoenix, Arizona
Full-time

Belong, Connect, Grow, with KBR!.KBR’s Global Asset Management (GAM) group provides comprehensive manufacturing and supply chain solutions globally, serving both commercial and government clients.W...Show more

Travel Sterile Processing Tech in Phoenix, AZ

AlliedTravelCareersPhoenix, Arizona, US
Full-time

Competitive weekly pay (inquire for details) .AlliedTravelCareers is working with SkyBridge Healthcare to find a qualified Sterile Processing Tech in Phoenix, Arizona, 85016!.SkyBridge Healthcare i...Show more

 • Promoted

Commercial Loan Processing & Closing Supervisor

Arizona Financial Credit UnionPhoenix, AZ, United States
Full-time

Commercial Loan Processing And Closing Team Supervisor.This position is responsible for providing day-to-day operational supervision and oversight of the Commercial Loan Processing and Closing Team...Show more

Warehouse Sorter

StaffmarkTolleson, AZ, United States
Full-time

Now hiring warehouse sorter in Tolleson, AZ.Shift: Mondays, Tuesdays, Thursdays, Fridays, Saturdays (3:00 AM 9:00 AM).Start times are dependent on mail volume.Move it, stack it, ship ityour next wa...Show more

Sterile Processing Technician

United Surgical Partners International Inc (USPI)Phoenix, AZ, US
Full-time

USPI Arizona Specialty Hospital is currently hiring a Full Time Sterile Processing Technician.USPI Arizona Specialty Hospital is a specialty inpatient hospital which was established to set a new st...Show more

IT - Lead Consultant | Big Data - Data Processing | Spark

Tek NinjasPhoenix, AZ, United States
Full-time
Quick Apply

Job Title:Consultant - Infrastructure Management | Big Data - Data Processing | Spark Work Location: Phoenix, AZ 85054 Contract duration: 6 months Job Details:&...Show more

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Quality Control Claims Audit Technician-Claims processing-Medicare/Medicaid experience required- Hybrid

Quality Control Claims Audit Technician-Claims processing-Medicare/Medicaid experience required- Hybrid

Blue Cross Blue Shield of ArizonaPhoenix, AZ, United States
8 days ago
Job type
  • Full-time
Job description

Internal Auditor

Performs internal audit reviews. Ensures accurate payment for all claim types and verifies demographic information is loaded correctly in accordance with the Arizona Health Care Cost Containment System and the Centers for Medicare and Medicaid services requirements, rules, regulations, and contract agreements.

Qualifications

Required Work Experience

  • Levels 1 and 2: 3 years in a managed care environment, 3 years of claims processing, 2 years of processing or auditing Medicaid or Medicare Part A and B claims
  • Level 3: 4 years in a managed care environment, 3 years of claims processing, 3 years of processing or auditing Medicaid and Medicare Part A and B claims

Required Education

  • High-School Diploma or GED in general field of study (Applies to All Levels)

Required Licenses

  • N/A

Required Certifications

  • N/A

Preferred Qualifications

Preferred Work Experience (Applies to All Levels)

  • N/A

Preferred Education

  • Associate's Degree in Business or Healthcare field of study. (Applies to All Levels)

Preferred Licenses

  • N/A

Preferred Certifications

  • Certified Professional Coder (applies to all levels)

Essential Job Functions and Responsibilities

Level 1

  • Ensures the quality of work within the organization by performing random quality audits of claims processed for one audit type or Line of Business.
  • Performs audits on provider information and/or Contracts.
  • Researches root cause of claim issues, determines corrective action to resolve it, communicates and documents findings.
  • Applies new information (e.g. AHCCCS policies, AHCCCS encounter changes, Medicare procedures and processes, etc.) to the audits.
  • Analyzes and documents audit results by tracking and trending audit results and report findings.
  • Identifies process improvements opportunities.
  • Supports the audit needs of the organization by completing ad-hoc analysis and reports upon request.
  • Performs other duties as assigned by completing other tasks as assigned to assist with operations of the internal department and other functional areas.

Level 2

  • Ensures the quality of work within the organization by performing random quality audits of claims processed.
  • Conducts financial accuracy audits on all claims paid greater than a value of $2,500.00.

Level 3

  • Applies and communicates new information (e.g. AHCCCS policies, AHCCCS encounter changes, Medicare procedures and processes, etc.) to the audit staff and/or other departments, assist in the maintenance of templates and forms and ensure their distribution to applicable departments and staff.
  • Supports the internal audit team by answering job-related technical questions, transfers knowledge through training, assist with assigning and monitoring workload, train new internal auditors and assist in the development and maintenance of training materials, including but not limited to: desk reference manuals, Medicaid and Medicare updates.
  • Cross-train levels 1-2 auditors

All Levels

  • Each progressive level includes the ability to perform the essential functions of any lower levels and assist / mentor employees in those levels.
  • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  • Perform all other duties as assigned.

Competencies

Required Job Skills (Applies to All Levels)

  • Strong experience on different payment methodologies
  • Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
  • Intermediate PC proficiency
  • Intermediate proficiency in spreadsheet, database and word processing, and presentation software
  • Knowledge of medical terminology
  • Knowledge of ICD-10-CM and PCs
  • Knowledge of CPT Codes and HCPCs codes
  • Knowledge of Medicaid and Medicare rules, regulations and guidelines
  • Claims processing/Auditing
  • Knowledge of all claim forms and types (UB04, 1500 and ADA)

Required Professional Competencies (Applies to All Levels)

  • Analytical skills to support independent and effective decisions
  • Prioritize tasks and work with multiple priorities, sometimes under limited time constraints.
  • Perserverance in the face of resistance or setbacks.
  • Effective interpersonal skills and ability to maintain positive working relationship with others.
  • Verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts.
  • Working knowledge of HIPAA and privacy requirements
  • Maintain confidentiality and privacy
  • Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data

Required Leadership Experience and Competencies (Applies to All Levels)

  • N/A

Preferred Competencies

Preferred Job Skills (Applies to All Levels)

  • Advanced skill in use of office equipment, including copiers, fax machines, scanner and telephones
  • Advanced PC proficiency
  • Advanced proficiency in spreadsheet, database and word processing software

Preferred Professional Competencies (Applies to All Levels)

  • Identify solutions to meet customer needs
  • Work with ambiguous and conflicting information while keeping focused on the end goal.

Preferred Leadership Experience and Competencies (Applies to All Levels)

  • N/A

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.