Claims Coordinator

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 14 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

About the role

The Claims Coordinator is a multi-faceted position that will support various areas of the Claims Department. Responsibilities include documenting, analyzing, and transmitting medical documents to appropriate departments; assisting with inbound provider phone calls; responding to internal emails regarding claims issues; collaborating with claims examiners to resolve issues; and communicating resolutions to providers and internal departments.

Responsibilities

• Review and analyze claims in AZPC’s processing system (EZ-CAP) for appropriate Prior Authorizations and/or Case Management IDs for processing of claims
• Work data integrity reports
• Communicate with providers in a courteous and timely manner
• Prepare medical records for scanning and routing to the appropriate department(s)
• Scan medical records into the document management system
• Analyze claims to determine if medical records are required for processing
• Review medical records for verification of contracted or non-contracted ordering and/or referring providers
• Provide follow-up on outstanding review requests
• Process denied claims based on reviewer determinations, or route to examiners as appropriate
• Perform other document control and management activities as assigned, including opening and sorting mail and data entry of claims
• Identify and communicate process improvement opportunities to the management team
• Perform eligibility validation inquiries and documentation with a high degree of speed and accuracy
• Handle incoming calls, inquiries, or concerns in a positive and helpful manner, seeking resolution and follow-up within 24 hours
• Process daily incoming documents received via mail and fax
• Respond to provider inquiries in a timely and professional manner
• Perform claim data integrity validation checks
• Follow established policies, formats, procedures, and timelines to complete assigned tasks
• Perform other duties as assigned

Requirements

• High school diploma or equivalent (GED)
• Minimum 1 year of medical claims processing experience required
• Strong experience and knowledge of Claims, Medicare/Medicaid guidelines, ICD-9, HCPCS / CPT coding, HCFA 1500’s & UB04’s
• Prior experience in customer service preferred
• Knowledge of healthcare terminology
• Knowledge of various medical claim forms (e.g., Professional and Facility)
• Strong computer skills including touch typing and experience with Microsoft applications (Word, Excel, Outlook)
• Ability to read and interpret documents such as processing and procedure manuals, medical terminology, and claims rules and regulations
• Demonstrate personal initiative, team spirit, and service orientation while maintaining a positive, caring, and professional attitude
• Strong organizational skills and the ability to work independently and under pressure on time-sensitive materials
• Excellent time management skills
• Strong attention to detail
• Must be able to work under the guidance of a Team Lead

Schedule

• Full-time in-office presence required for the first 60 days of employment
• Hybrid schedule available after initial training period

Pay

Compensation range: $19 – $21 per hour