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SalaryAwarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
PURPOSE OF THE JOB
Order, retrieve, match, research and process Medical Records received for both pre-payment and post- payment reviews for claims with strong emphasis on confidentiality and PHI. Also responsible for updating computer systems.
QUALIFICATIONS
REQUIRED QUALIFICATIONS
1. Required Work Experience
- 2 years of general correspondence experience
2. Required Education
- High-School Diploma or GED in general field of study
3. Required Licenses
- N/A
4. Required Certifications
- N/A
PREFERRED QUALIFICATIONS
1. Preferred Work Experience
- 1 year of experience in medical or health insurance field
- 1 year of experience using Claims Processing system
- 1 year of experience using proprietary Blue systems
- 1 year of telephone experience
2. Preferred Education
- N/A
3. Preferred Licenses
- N/A
4. Preferred Certifications
- N/A
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
- Maintain productivity and accuracy requirements.
· Order Medical Records for a variety of lines of business (local, Blue Card, FEP). · Receive and research all Medical Records received to match to appropriate file for processing.
- Prescreen Medical Records to determine if necessary information received.
- Provide back up review aging report for open contacts as directed to ensure timeliness standards are met.
- Responsible for researching and responding to inquiries.
- Provides training and mentoring to staff.
- Participate on special teams and projects as assigned by management.
- Perform focused quality sampling
- Create job aids and maintains desk level procedures as needed
- Request Medical Records with special attention to confidentiality, PHI, adhering to corporate standards, State and Federal regulations and mandates.
- Process letter files, reviewing for accuracy and sorting to prepare for mailing.
- Request Medical Records for claims. Ensure requests are sent to appropriate Blue Plans.
- Research error reports
- Identify and perform research of Medical Records and other correspondence received in the department.
- Perform system location moves of pending claims
- Monitor systems to retrieve Medical Records
- Respond to inquires from other Blue Plans related to medical record request questions adhering to strict response time required by the BCBS Association.
- Retrieve and research phone messages and respond or direct the calls to the appropriate area for resolution. Set up contacts in the system for re-directed calls.
- Monitor, clipboard and process faxes received for research
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Perform all other duties as assigned.
COMPETENCIES
REQUIRED COMPETENCIES
1. Required Job Skills
- Intermediate skill using office equipment including fax machines, scanner, and telephones
- Basic PC proficiency
- Basic skill in word processing, spreadsheet and database software
2. Required Professional Competencies
- Maintain confidentiality and privacy
- Perform investigative and analytical research
- Establish and maintain working relationships in a collaborative team environment
- Follow and accept instruction and direction
3. Required Leadership Experience and Competencies
- N/A
PREFERRED COMPETENCIES
1. Preferred Job Skills
- Advanced skill using office equipment including fax machines, scanner, and telephones
- Advanced PC proficiency
- Advanced skill in word processing, spreadsheet and database software
2. Preferred Professional Competencies
- Handling of Medical Records and correspondence
- Claims Processing and imaging systems
3. Preferred Leadership Experience and Competencies
- N/A
Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.
