Claims Specialist II - Tucson, AZ (Corporate-Bonita)

Looking to build a lasting career?  Join a team that is inclusive 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 packages
• Exceptional health, dental, and disability benefits
• Career and compensation advancement programs
• Student loan forgiveness programs
• 401k company match
• Bilingual pay differential
• Holiday, PTO and employer paid life insurance
• Clinical licensure supervision and reimbursement
• Evidence-based treatment approaches, training, and supervision
• One 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.

General Summary:  Responsible for performing all levels of claims processing.

JOB RESPONSIBILITIES:

• Prepare claims for billing, ensure all claims are valid and authorized per the contracts. 
• Validate claim details, ensuring all information, such as patient demographics, provider information, service dates, and charges, is correctly entered.
• Includes running pre-billing reports to review for accuracy. Collaborate with clinical staff to resolve coding, documentation issues or non-billable services that could delay claims processing.
• Track submitted claims to ensure that they are transmitted successfully through the clearinghouse and received by the payer.
• Claim Edits:
  • Review claim edit reports generated by the EHR system to identify and correct errors prior to submission.
  • Investigate coding discrepancies or mismatches in payer-specific guidelines to resolve edits.
  • Correct common claim edit errors, such as missing diagnosis codes, incorrect modifier usage, or mismatched provider information.
  • Resubmit corrected claims within designated timeframes to avoid delays in reimbursement.
• Claim Rejections:
  • Monitor and manage rejected claims, working closely with clearinghouses and payers to understand rejection reasons (e.g., missing authorizations, incorrect patient eligibility, provider credentialing errors, missing claim information).
  • Keep up to date with payer policies, Medicaid/Medicare guidelines, and industry best practices for claims management.
  • Maintain detailed records of rejected claims, including the reason for rejection and actions taken to correct and resubmit.
• Payment Posting and Reconciliation:
  • Accurately post payments received from insurance payers, patients, and government programs into the EHR or practice management system.
  • Ensure that all EOBs (Explanation of Benefits) are reviewed and applied to the correct patient accounts and that co-pays, deductibles, and co-insurance amounts are properly recorded.
  • Accurately post patient responsibility amounts such as co-pays, deductibles, and co-insurance.
  • Ensure that all payer adjustments and contractual allowances are posted properly to reflect accurate account balances.
  • Generate regular reports on claim rejections, resubmissions, and payments to identify patterns and opportunities for process improvement.
• Communication and Collaboration:
  • Collaborate with other departments, including Member Services, member registration, and clinical teams, to resolve patient eligibility or authorization issues that may impact billing.
• Maintains current knowledge including changes to federal and state regulations related to Medicaid, Medicare, and other healthcare billing practices.
• Create and maintain timely guidelines for all payers
• Knowledge of CPT, ICD-10, HCPC codes/coding
• Maintain HIPAA compliance at all times by safeguarding patient information and ensuring confidential data is handled appropriately.
• Monitor clean and rejected claim rate percentages.

QUALIFICATIONS:

• Education – HS/GED required
• Certification – Associates Degree or certification in Medical Billing and Coding is preferred
• Experience –

• Minimum of 2-3 years of experience in medical billing or revenue cycle management, with a focus on claims processing, rejections and payment posting. preferred.
• Familiarity with EHR systems and clearinghouses (e.g., WayStar) for claims submission and payment posting.
• Strong understanding of medical terminology, CPT, ICD-10, and HCPCS coding systems.
• Excellent attention to detail, with the ability to manage large volumes of claims accurately and efficiently.
• Strong communication and customer service skills to resolve billing inquiries and collaborate with clinical teams.

REGULATORY:

• 21 years of age
• Current, valid Arizona Driver’s License, 39-month Motor Vehicle Report and proof of vehicle registration and liability coverage to meet insurance requirements.
• Eligible for DPS Level I fingerprint clearance.
• First Aide, CPR certification (Employer provides)
• Initial current negative TB test result, within the prior 12 months. (Employer provides)

Questions about this position?  Contact us at HR@ichd.net.

ICHD is an equal opportunity employer.  ICHD does not discriminate based on age, ethnicity, race, sex, gender, religion, national origin, creed, tribal affiliation, ancestry, gender identity, sexual orientation, marital status, genetic information, veteran status, socio-economic status, claims experience, medical history, physical or intellectual disability, ability to pay, source of payment, mental illness, and/or cultural and linguistic needs, as well as any other class protected by law.