Billing Processor

• 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.

• Applies provider contract provisions to determine if claim is payable or denied. 

• Determines if denied claims related to rendering provider, service location, coordination of benefits, refunds or adjustments.

• Reviews medical and behavioral claims, post payment or denial codes within established department guidelines and standards

• Maintain records, files, and documentation as appropriate

• Maintains billing, explanation of benefits, and Receipts filing system and records retention.

• 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.

• Meet department production and quality standards

• Performs other related duties in accordance with agency growth and changes.

Additional Essential Duties and Responsibilities for 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.

• Responsible to communicate and resolve 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. 

• Point of contact for communicating directly with the Medicaid provider representative.

• Point person to communicate and resolve denials and rejections for the assigned Medicaid payer.

• Reconciles Medicaid payer monthly payments to EFTs and communicates discrepancies to the supervisor.

• Assists billing team members with denied and pended billing errors.

• Assists with training specific to the assigned Medicaid payer.

Additional Essential Duties and Responsibilities if Certified Professional Coder

• Answer calls and emails related to coding.

• Review denial notes to determine correctness in diagnosis, modifier & CPT code 
  Assist providers in selecting correct CPT codes

• Assist Data Validation Audits

Billing Processor I:

• 3 years billing & claims processing experience 

Billing Processor II:

• A minimum of 5 years billing & claims experience AND;
• A minimum of 1 year processing claims as assigned to the primary Medicaid ERA funder 

Certified Professional Coder

• Active AAPC Certification

Certifications:

• Certified Coder, preferred

Additional Requirements:

• Valid Arizona Drivers license, proof of current insurance and 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