Medical Claims Processor - Corporate

Looking to build a lasting career?  Join a team that is inclusive of all and embraces all individuals.  Intermountain Centers is one of the largest statewide behavioral health and integrated care organizations in Arizona.  What does building a lasting career look like:Top-level compensation packagesExceptional health, dental, and disability benefitsCareer and compensation advancement programsStudent loan forgiveness programs401k company matchBilingual pay differentialHoliday and PTOClinical licensure supervision and reimbursementEvidence-based treatment approaches, training, and supervisionOne of the first fully vaccinated COVID-19 workplaces in Arizona Intermountain Centers and its statewide affiliates, Community Partners Integrated Healthcare, Pinal Hispanic Council, Intermountain Health Center, Intermountain Foster Care, Behavioral Consultation Services and MHRI Housing are currently recruiting career-minded individuals interested in opportunities within the largest adult and child service continuum in Arizona.  Intermountain Centers is committed to the safety and well-being of our employees, our members, and the communities we serve and, as such, we require all employees to be fully vaccinated from the COVID-19 virus.  Proof of full vaccination status is required prior to the start of employment.  Medical or religious waivers may be requested.  Contact the HR recruiting team for more information. Proof of COVID-19 vaccination required. General Summary:  Responsible for preforming all levels of claims processing and review.   Job Responsibilities:               Prepares all claims for billing, ensuring all claims are valid and authorized per the contracts.  Includes running pre-billing reports to review for accuracy and running non-billable services report to ensure all billing is captured.  Non-billable service reports should be communicated to Program Directors. Claims submission to Commercial plans, AHCCCS and Regional Behavioral Health Authority (RBHA), both contracted and non-contracted, for final resolution. Ensures accurate and timely filing. Reprocessing of denied claims with follow up to paid resolution/adjustment Recognizing and reporting trendsValidates NPI/Tax IDValidates payor ID Departmental goal is to be under 120 days for file rejections and denied claims Works with EVOLV systems and Internal Departments   COB/TLP claims processing Appeals and Grievances Self-pay plan review/billing Payment posting Ensures claim files are submitted accordingly.  Submission should not exceed 30 days from initial service date or 60 days for claim rejections and/or denials Produces reports for internal and external customers and assists in the preparation of presentations for upper management and providers Attends meetings related to the claims system     Completes EVOLV trainings Maintains current knowledge of Billing Rules and Guidelines. Create and maintain timely guidelines for all payers Knowledge of CPT, ICD-10, HCPC codes/coding All other duties as deemed necessary Maintains an approved schedule and acceptable level of attendance. QUALIFICATIONS: Education – HS/GED Certification – Certified Professional Coder or AAPC/AMA Certification preferred Experience –5 years claims processing experience preferred.Behavioral Health billing experience preferred.RegulatoryMinimum 21 years of age.Arizona Level One Fingerprint Clearance Card (must possess upon hire and maintain throughout employment).CPR, First Aid & AED certification, if required (must possess upon hire and maintain throughout employment).Valid Arizona Driver’s License, 39-month Motor Vehicle Report, proof of vehicle registration and liability insurance that meet company insurance requirements, if required.Negative TB test result, if required (Employer provides). If you have any questions, please reach out to the Recruiter for this position: Melissa Garcia Human Resources Generalist mgarcia@ichd.net