Claims Clinical Documentation Reviewer
State of Arizona —Phoenix, AZ
- $68,000 - $71,032 a year
- Full-time
- Background check
- Writing skills
- Research
- Paid parental leave
- Paid holidays
Data Entry & Medical Records Specialist
State of Arizona —Phoenix, AZ
- $16.11 an hour
- Full-time
- Background check
- Microsoft Excel
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- Paid parental leave
- Paid holidays
Assistor Communications Coordinator
State of Arizona —Phoenix, AZ
- $40,560 a year
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CORRECTIONAL ADMINISTRATIVE INVESTIGATOR
State of Arizona —Phoenix, AZ
- $67,209 a year
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- Current TB test
- 5 years
- Writing skills
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- Paid parental leave
13d
Human Resources Analyst
State of Arizona —Phoenix, AZ
- $48,000 - $50,500 a year
- Full-time
- Hybrid work
- Background check
- Clean driving record
- Writing skills
- Paid parental leave
- Paid holidays
11d
Courtroom Assistant - Classified
Judicial Branch of Arizona in Maricopa County —Phoenix, AZ
- $22.09 - $33.00 an hour
- Full-time
- Spanish
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- English
- Wellness program
- Paid holidays
COMPLAINT INVESTIGATOR
State of Arizona —Phoenix, AZ
- $66,000 - $71,500 a year
- Full-time
- Hybrid work
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Paid parental leave
- Paid holidays
5d
Procurement Specialist
State of Arizona —Phoenix, AZ
- $55,000 - $65,000 a year
- Full-time
- Remote
- Google Workspace
- ERP systems
- Research
- Paid parental leave
- Paid holidays
IT Project Manager
State of Arizona —Phoenix, AZ
- $75,000 - $80,000 a year
- Full-time
- Remote
- Google Workspace
- Research
- Mid-level
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- Paid holidays
ESS, SPECIAL EDUCATION INCLUSION SPECIALIST
State of Arizona —Phoenix, AZ
- $66,000 - $72,000 a year
- Full-time
- Hybrid work
- School experience
- Microsoft Excel
- Microsoft Outlook
- Paid parental leave
- Paid holidays
3d
Community Relations Administrator
State of Arizona —Phoenix, AZ
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- Mid-level
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- Paid holidays
ESEA CONSOLIDATED EDUCATION PROGRAM SPECIALIST
State of Arizona —Phoenix, AZ
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- Hybrid work
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- Paid holidays
Care Management Healthcare Consultant
State of Arizona —Phoenix, AZ
- From $71,032 a year
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- Hybrid work
- Background check
- RN License
- Research
- Paid parental leave
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6d
Clinical Quality Management Coordinator
State of Arizona —Phoenix, AZ
- From $71,032 a year
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- Hybrid work
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Informatics & Prepayment Review Health Consultant
State of Arizona —Phoenix, AZ
- From $71,032 a year
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EMPLOYEE RELATIONS SUPERVISOR
State of Arizona —Phoenix, AZ
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- Computer literacy
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10d
ENVIRONMENTAL TECHNICIAN 1-3
State of Arizona —Phoenix, AZ
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BH PA/UR Consultant
State of Arizona —Phoenix, AZ
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Trng Offcr 2
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4d
Special Projects Advisor, CSOC
State of Arizona —Phoenix, AZ
- $68,000 - $74,000 a year
- Full-time
- Background check
- Mid-level
- 3 years
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11d

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Claims Clinical Documentation Reviewer

State of Arizona -
Phoenix, AZ

Apply Now

Job Details

Full-time
$68,000 - $71,032 a year

Benefits

Paid parental leave
Paid holidays
Disability insurance
Health insurance
Dental insurance
Parental leave
Loan forgiveness

Qualifications

Data-driven problem-solving

Full Job Description

541748

PHOENIX
REMOTE OPTIONS
VARIOUS-STATEWIDE

AHCCCS

Full-time

AHCCCS

Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.

AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.

Come join our dynamic and dedicated team.

Claims Clinical Documentation Reviewer

Division of Fee for Service (DFSM)

Job Location:

Address: 150 North 18th Avenue Phoenix, Arizona 85007

This position has the potential to work from a Virtual Office (VO) setting or may Telecommute based on the needs of the unit and at the discretion of leadership.

Posting Details:

Salary: $68,000 - $71,032

Grade: 21

Closing Date: Open until filled

Job Summary:

Claims Clinical Documentation Reviewer reports to the Prepayment Program Manager and is responsible for reviewing clinical and/or supportive documentation, submitted by provider organizations, in support of billed medical, behavioral health, NEMT and other related Medicaid services by applying knowledge of healthcare State, Federal, and AHCCCS laws, policies, and practices. This position will provide monitoring and technical assistance to ensure compliance with contractual, regulatory, and statutory obligations for a variety of Fee-for-Service (FFS) services. Monitor over and under service utilization, conduct prepayment claims reviews, provide oversight and technical assistance, gather, plan, organize and evaluate information from multiple sources, including utilization data, case file reviews and audits. Coordinate with external and internal stakeholders as needed, make referrals as necessary, participate in clinical staffing and/or related claims centered meetings as needed, serve as a resource for medically necessary covered services.

The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State’s Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.

Major duties and responsibilities include but are not limited to:

Conduct Pre-Payment Claim Reviews for medical necessity, appropriateness of services, quality of care and common billing errors, for a variety of treatment service types, on a daily basis. Conduct in-depth audits, involving independent reviews and analysis, formulation of an audit report and possible presentation of findings.
Become efficient in utilizing the Arizona Health Care Cost Containment System (AHCCCS) information system called Prepaid Medical Management Information System (PMMIS), in order to process pre-payment reviewed claims.
Participate in team meetings, huddle boards and similar meetings, in order to learn about new process updates and internal policy changes. Facilitate a team meeting or huddle board, on a rotating basis.
Actively review claims information and its supportive documents to either approve or deny a claim. Review clinical documentation submitted by provider organizations in support of billed medical and behavioral health services by applying knowledge of healthcare State, Federal, and AHCCCS laws, policies, and practices.
Participate in the development and delivery of trainings relating to the improvement of the overall prepayment claims review process.
Participate in, in-person clinical provider reviews by conducting provider on-site visits with the DFSM Quality of Care units as needed. Participate in internal and external meetings as requested to collaborate with others and ensure full understanding of team and departmental workflows.

Knowledge, Skills & Abilities (KSAs):

Knowledge:

Service Authorization concepts, principles, and strategies
Advanced knowledge of the behavioral health service delivery system and the needs of children and the needs of individuals designated as SMI
Principles of behavioral health management and assessment
Individual service planning process and substance abuse treatment
HCPCS codes Levels I & II and, knowledge of International Classification of Diseases, DSM IV/V coding and medical billing guidelines
Medical technology, computer data retrieval and input, including EHR, HIE, etc
Medicaid and Medicare Federal Regulations, State Statute, Rules, and Policies applicable to AHCCCS programs
AHCCCS program design and implementation, prior authorization functions and responsibilities, provider network, and funding source
Familiarity with American Indian Tribes, programs and policy

Skills:

Problem solving identification, evaluation, and imitation of appropriate action and case management assessment
Excellent verbal/written communication skills, with FFS Providers
Organizational skills to coordinate, monitor and report on multiple cases simultaneously
Analytical skills to identify and correlate specific patterns, initiate investigations, submit findings and recommendations
Strong interpersonal skills in working with people of diverse cultures and socioeconomic backgrounds
Documentation, research, and reporting of data and trends
Strong computer skills including Microsoft and Google Suite

Abilities:

Strong ability to collaborate with others for mutually beneficial outcomes
Interpret clinical information and assess implications for treatment
Read, interpret, and apply complex rules and regulations
Independent decision making yet knowing when to elevate the decision
Drive long distances when required
Ability to work Telecommute

Selective Preference(s):

Arizona Driver's License

Minimum: Two to three years clinical and programmatic experience working with the behavioral health service delivery systems. Quality Management and/or Compliance Certification within the field of behavioral health, or Arizona Licensed Nurse, or Behavioral Health Professional (independent/associate license within AZ).

Preferred: Advanced experience in clinical and/or claims supportive documentation review and analysis.

Pre-Employment Requirements:

Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.

If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Benefits:

Among the many benefits of a career with the State of Arizona, there are:

10 paid holidays per year
Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
Other Leaves - Bereavement, civic duty, and military.
A top-ranked retirement program with lifetime pension benefits
A robust and affordable insurance plan, including medical, dental, life, and disability insurance
Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
RideShare and Public Transit Subsidy
A variety of learning and career development opportunities

By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

Learn more about the Paid Parental Leave pilot program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Retirement:

Lifetime Pension Benefit Program

Administered through the Arizona State Retirement System (ASRS)
Defined benefit plan that provides for life-long income upon retirement.
Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program

Voluntary participation.
Program administered through Nationwide.
Tax-deferred retirement investments through payroll deductions.

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

Apply Now

Refine Your Search

remote medical interpreter jobs in phoenix, az

Claims Clinical Documentation Reviewer

Data Entry & Medical Records Specialist

Assistor Communications Coordinator

CORRECTIONAL ADMINISTRATIVE INVESTIGATOR

Human Resources Analyst

Courtroom Assistant - Classified

COMPLAINT INVESTIGATOR

Procurement Specialist

IT Project Manager

ESS, SPECIAL EDUCATION INCLUSION SPECIALIST

Community Relations Administrator

ESEA CONSOLIDATED EDUCATION PROGRAM SPECIALIST

Care Management Healthcare Consultant

Clinical Quality Management Coordinator

Informatics & Prepayment Review Health Consultant

EMPLOYEE RELATIONS SUPERVISOR

ENVIRONMENTAL TECHNICIAN 1-3

BH PA/UR Consultant

Trng Offcr 2

Special Projects Advisor, CSOC

I want to receive the latest job alert for remote medical interpreter in phoenix, az

Related Searches

Explore jobs in more locations

AHCCCS

Claims Clinical Documentation Reviewer

Division of Fee for Service (DFSM)

Address: 150 North 18th Avenue Phoenix, Arizona 85007

This position has the potential to work from a Virtual Office (VO) setting or may Telecommute based on the needs of the unit and at the discretion of leadership.

Salary: $68,000 - $71,032

Grade: 21

Closing Date: Open until filled

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