Title: Claims Specialist 1

• 525487

• PHOENIX
• REMOTE OPTIONS

• AHCCCS

• Full-time

The Division of Fee For Service Management (DFSM) is looking for a highly motivated individual to join our team as an Claims Specialist 1. This position reports to the Data Processing Manager and is responsible for transferring data from paper formats into computer files or database systems. The transfer of data happens manually or using AHCCCS Optical Character Recognition (OCR) claim system. The position will type and verify all claim information as submitted by the provider to ensure timely claim processing.

The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the States Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.

• Accurately input a high volume of data from multiple sources into a database, ensuring that all necessary data is being entered as submitted by the provider. Entering data by a manual process and /or correcting fields and completing missing key fields in an Optical Character Recognition (OCR) system.
  
• Entry and transcribing from paper formats into computer files of medical claims, form types CMS 1500s, UB04s, and ADA Dental Forms while meeting established quality and production standards.
  
• Functions also includes pulling up the image of the claim, verifying the documentation attached for Medicare Explanation of Benefits (EOBs), and third party liability, verifying key fields on the claim.
  
• Escalates issues and/or problem claims to supervisor/manager.

Knowledge of:

• Medical terminology used on medical claims.
  
• Diagnostic and procedural coding used on medical claims.
  
• Medicare and third party liability insurance.
  
• Windows and/or Optical Character Recognition (OCR) environment.
  
• Billing claim forms.
  
• Basic mathematics and statistical analysis.
  

Skill in:

• Concepts of research.
  
• Computer skills: operating keyboard, ten-key calculator.
  
• Type accurately with adequate speed.
  
• Professionalism and strong work ethic.
  

Ability to:

• Communicate verbally and in writing.
  
• Work effectively independently and/or as part of a team.
  
• Identify problem claims and elevate in a timely manner.
  
• Prioritize projects and have the ability to change priorities based on teams needs.
  
• Meet daily quota with large volume of claims with similar tasks.
  
• Position has the potential to work from a Virtual Office (VO) setting or may Telecommute based on the needs of the unit and at the discretion of leadership.

Minimum Qualifications:

• High School Diploma (or equivalent)
  
• Experience with computer applications such as Microsoft Office or Google Suites.
  

Preferred Qualifications:

• Up to 6 months of data entry experience.

* Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
* Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agencys ability to reasonably accommodate any restrictions.
* Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.

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: Drivers License Requirements.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Among the many benefits of a career with the State of Arizona, there are:
* 10 paid holidays per year
* Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
* Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
* Other Leaves - Bereavement, civic duty, and military.
* A top-ranked retirement program with lifetime pension benefits
* A robust and affordable insurance plan, including medical, dental, life, and disability insurance
* Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
* RideShare and Public Transit Subsidy
* A variety of learning and career development opportunities

By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

Learn more about the Paid Parental Leave pilot program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Lifetime Pension Benefit Program
* Administered through the Arizona State Retirement System (ASRS)
* Defined benefit plan that provides for life-long income upon retirement.
* Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
* Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program
* Voluntary participation.
* Program administered through Nationwide.
* Tax-deferred retirement investments through payroll deductions.

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.
Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.