Job Description

Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.

Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering 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.

Internal use only-grade 11-12

Performs internal audit reviews. Ensures accurate payment for all claim types and verifies demographic information is loaded correctly in accordance with the Arizona Health Care Cost Containment System and the Centers for Medicare and Medicaid services requirements, rules, regulations, and contract agreements.

REQUIRED QUALIFICATIONS

Required Work Experience

Levels 1 and 2:

o   3 years in a managed care environment

o   3 years of claims processing

o   2 years of processing or auditing Medicaid or Medicare Part A and B claims

Level 3:

  • 4 years in a managed care environment
  • 3 years of claims processing
  • 3 years of processing or auditing Medicaid and Medicare Part A and B claims

Required Education

  • High-School Diploma or GED in general field of study (Applies to All Levels)

Required Licenses

  • N/A

Required Certifications

  • N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience (Applies to All Levels)

  • N/A

Preferred Education

  • Associate’s Degree in Business or Healthcare field of study. (Applies to All Levels)

Preferred Licenses

  • N/A

Preferred Certifications

  • Certified Professional Coder (applies to all levels)

 

ESSENTIAL job functions AND RESPONSIBILITIES

Level 1

  • Ensures the quality of work within the organization by performing random quality audits of claims processed for one audit type or Line of Business.
  • Performs audits on provider information and\or Contracts.
  • Researches root cause of claim issues, determines corrective action to resolve it, communicates and documents findings.
  • Applies new information (e.g. AHCCCS policies, AHCCCS encounter changes, Medicare procedures and processes, etc.) to the audits. 
  • Analyzes and documents audit results by tracking and trending audit results and report findings.
  • Identifies process improvements opportunities.
  • Supports the audit needs of the organization by completing ad-hoc analysis and reports upon request.
  • Performs other duties as assigned by completing other tasks as assigned to assist with operations of the internal department and other functional areas.

Level 2

  • Ensures the quality of work within the organization by performing random quality audits of claims processed. 
  • Conducts financial accuracy audits on all claims paid greater than a value of $2,500.00. 

Level 3

  • Applies and communicates new information (e.g. AHCCCS policies, AHCCCS encounter changes, Medicare procedures and processes, etc.) to the audit staff and/or other departments, assist in the maintenance of templates and forms and ensure their distribution to applicable departments and staff. 
  • Supports the internal audit team by answering job-related technical questions, transfers knowledge through training, assist with assigning and monitoring workload, train new internal auditors and assist in the development and maintenance of training materials, including but not limited to: desk reference manuals, Medicaid and Medicare updates.
  • Cross-train levels 1-2 auditors

ALL LEVELS

  • Each progressive level includes the ability to perform the essential functions of any lower levels and assist / mentor employees in those levels.
  • 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.

REQUIRED COMPETENCIES

Required Job Skills (Applies to All Levels)

  • Strong experience on different payment methodologies
  • Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
  • Intermediate PC proficiency
  • Intermediate proficiency in spreadsheet, database and word processing, and presentation software
  • Knowledge of medical terminology
  • Knowledge of ICD-10-CM and PCs
  • Knowledge of CPT Codes and HCPCs codes
  • Knowledge of Medicaid and Medicare rules, regulations and guidelines
  • Claims processing/Auditing
  • Knowledge of all claim forms and types (UB04, 1500 and ADA)

Required Professional Competencies (Applies to All Levels)

  • Analytical skills to support independent and effective decisions
  • Prioritize tasks and work with multiple priorities, sometimes under limited time constraints.
  • Perseverance in the face of resistance or setbacks.
  • Effective interpersonal skills and ability to maintain positive working relationship with others.     
  • Verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts.
  • Working knowledge of HIPAA and privacy requirements
  • Maintain confidentiality and privacy 
  • Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data

Required Leadership Experience and Competencies (Applies to All Levels)

  • N/A

PREFERRED COMPETENCIES

Preferred Job Skills (Applies to All Levels)

  • Advanced skill in use of office equipment, including copiers, fax machines, scanner and telephones
  • Advanced PC proficiency
  • Advanced proficiency in spreadsheet, database and word processing software

Preferred Professional Competencies (Applies to All Levels)

  • Identify solutions to meet customer needs
  • Work with ambiguous and conflicting information while keeping focused on the end goal.

Preferred Leadership Experience and Competencies (Applies to All Levels)

  • N/A

Our Commitment

BCBSAZ 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

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.


Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross® BlueShield® of Arizona



Posted 16 Days Ago

Full time

R1006

Application Instructions

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