Billing Processor

Billing Processor I

• 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.
• Determines if denied claims related to rendering provider, service location, coordination of benefits, refunds or adjustments.
• Maintains records, files, and documentation as appropriate.
• 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.
• Meets department production and quality standards.

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.
• Communicates and resolves 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.
• Communicates directly with the Medicaid provider representative.
• Communicates and resolves denials and rejections for the assigned Medicaid payer.
• Reconciles Medicaid payer monthly payments to EFTs and communicates discrepancies to the supervisor.
• Aids billing team members with denied and pended billing errors.
• Aids with training specific to the assigned Medicaid payer.

Certified Professional Coder

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

Qualifications

• Billing & Claims Processing experience: 3 years for Billing Processor I, 5 years for Billing Processor II.
• Processing claims as assigned to the primary Medicaid ERA funder: Required for Billing Processor II.
• Certified Professional Coder: Active AAPC Certification, preferred.
• Additional Requirements: Valid Arizona Drivers license, proof of current insurance, willingness to use personal vehicle, Clean Motor Vehicle Record - no more than 2 moving violations or a license suspension in past 3 years.

Skills

• Bilingual a plus.
• Ability to interact effectively with other service providers.
• Intermediate to advanced computer skills using MS Office products, Word, Excel, Access, etc., importing/exporting data to/from applications.
• Ability to communicate effectively both orally and in writing.