Claims specialist

DEPARTMENT OF ECONOMIC SECURITY

Your Partner For A Stronger Arizona.


DES works with families, community organizations, advocates and state and federal partners to realize our collective vision: A thriving Arizona.


DES serves more than 3 million Arizonans. Our Mission is to strengthen individuals, families, and communities for a better quality of life.

CLAIMS SPECIALIST 2

Job Location:

Division of Developmental Disabilities (DDD)
1789 West Jefferson Street, Phoenix, Arizona 85007

Posting Details:

Salary: $34,200.05 - $35,200.05

Grade: 15

Closing Date: April 16, 2024

Job Summary:

The Department of Economic Security, Division of Developmental Disabilities (DDD), is seeking an experienced and highly motivated individual to join our team as a Claims Specialist 2. DDD provides individuals with developmental disabilities, and their families, services and supports that are flexible, high quality, and member driven. These services empower individuals with developmental disabilities to lead self-directed, healthy, and meaningful lives.


Applicants for this position cannot be licensed or certified by the DDD Office of Licensing Certification and Regulation, cannot have a principal interest in or have a spouse or a close family with principal interest in a DDD Qualified Vendor Agreement, and cannot be employed or subcontracted by a DDD Qualified Vendor.

Job Duties:

Essential Duties and Responsibilities include but are not limited to:

• Manual processing within WellSky Human Services processing system of data entering claims, including the searching of the authorization number for the claims submitted by non-contracted providers.
• Manual process of performing reversals, voids, and overrides to claims within the WellSky Human Services system, and the FOCUS system. This is for both requests from the Research & Audit team as a result of audits, claim grievances, and claim disputes, and requests from Providers that have been approved by the Claims Supervisor or above.
• Gathers the physical claims that have been rejected for returning to the provider. Creates the letterhead that will be sent with the claims, detailing the reasons why the claims are being returned. Mails the letterhead, and claim back to the provider.

Knowledge, Skills & Abilities (KSAs):

Knowledge in:

• Principles and practices of accounting.
• Federal and state laws, AHCCCS rules and regulations as applied to processing medical claims.
• Diagnostic and procedural coding used on medical claims.

• Excellent Customer Services skills are a must.
• Excellent comprehensive oral and written communication.
• Problem solving.

• Review standard medical claims billing forms to ensure that all required fields are filled in.
• Obtain information from non-DDD systems to verify information is updated.
• Analyze billing problems and recommend usable solutions.

Selective Preference(s):

The ideal candidate will have:

• Familiarity with medical claims processing, third party liability and/or Coordination of Benefits. Google certification.

Pre-Employment Requirements:

• Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record in accordance with DES Fleet Management-Safety Program policy and procedures (DES 1-07-26 & DES 1-07-26-01). Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.
• All newly hired State employees are subject to and must successfully complete the Electronic Employment /Eligibility Verification Program (E-Verify).
• Successfully pass background and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.

Benefits:

The Arizona Department of Economic Security offers a comprehensive benefits package to include:

• Affordable medical, dental, life, and short-term disability insurance plans
• Participation in the Arizona State Retirement System (ASRS) and long-term disability plans
• 10 paid holidays per year
• Vacation time accrued at 4.00 hours bi-weekly for the first 3 years
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
• Sick time accrued at 3.70 hours bi-weekly
• Deferred compensation plan
• Wellness plans
• Tuition Reimbursement
• Stipend Opportunities
• Infant at Work Program
• Rideshare and Public Transit Subsidy
• Career Advancement & Employee Development Opportunities
• Flexible schedules to create a work/life balance

Retirement:

State employees are required to participate in the Arizona State Retirement System (ASRS), the State sponsored retirement contribution plan and the Long-Term Disability (LTD) program after a 27-week waiting period. The ASRS defined benefit plan provides for life-long income upon retirement. You will also have the option to participate in a voluntary deferred compensation program to take advantage of tax-deferred retirement investments.


On, or shortly after, your first day of work you will be provided with additional information about the available insurance plans, enrollment instructions, submission deadlines and effective dates.

Contact Us:

For questions about this career opportunity, please contact Wendy Browning at .


The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting . Requests should be made as early as possible to allow time to arrange the accommodation.