Interdepartmental Lead, Network
Our Mission: Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.
Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.
Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!
Position Purpose: Claims Lead- Interdepartmental Oversight is to act as a liaison between Reimbursement Services and other internal departments to help ensure communication and operational efficiencies.
- Track, monitor progress and ensure issue resolution for internal departments and priority claims through different internal processes from receipt to final disposition. Tracking may include mailroom/sftp sites, Network, data entry, scanning, fee schedule loads / updates, benefit configuration, claims processing, medical claims review, internal audit, final denial/paid date and notification to provider
- Develop and implement pathways between departments for operations
- Assist in ensuring claims turnaround time and accuracy goals are met in regards to High Dollar/Priority Claims. Interdepartmental Lead may also assist in processing claims, including high priority claims, which are inclusive of transplants
- This position may assist the Supervisor(s) with daily operations, as well as assisting with training and documentation
- Provide feedback to the supervisor(s) and trainer, through written and verbal documentation/communications, regarding claims issues, process improvements and other areas of concern
Education / Experience / Other Requirements
- High School Diploma or GED
- Associates Degree Preferred
Years of Experience:
- Three (3) years claims processing experience in CMS 1500, UB and electronic claims in a managed care environment
- Claims Processing, 1500s and UBs
- Knowledge of medical terminology
- Knowledge of ICD-10
- Knowledge of CPT Codes and HCPCS codes
- Understanding of internal operations of managed care environment
- Ability to supervise and lead others
- Ability to think analytically and make independent decisions
- Ability to manage large workload
- Ability to maintain positive work relationships
- Handle multiple and changing priorities at a fast pace
- Work cooperatively, positively, and collaboratively in an interdisciplinary team
- Computer experience necessary, including Excel
- Effective time management and organizational skills
- Effective interpersonal and communication skills