Magellan Health Services, Inc. Medicaid Claims Processor Educator - Phoenix commutable in Phoenix, Arizona
This job was posted by https://www.azjobconnection.gov : For more information, please see: https://www.azjobconnection.gov/ada/r/jobs/3985907 Ensures providers and prescribers are aware of health plan policy and requirements for claims submissions and/or PA requests. Conducts outbound calls and visits to prescribers or pharmacy providers who need assistance, or for proactive out reach. Travel may be required and varies by client (TBD). Additional responsibilities include reporting, letter preparation, and other duties to assist the network department in providing support to the client.
+ Supports provider outreach for planned operational activities through letter preparation, tracking and education.
+ Supports outcomes reporting for various projects.
+ Serves as the health plan`s representative in the field in partnership with Network to effectively communicate with providers about company policies, procedures, contractual requirements, regulators requirements and other issues related to claims.
+ Conducts provider site visits and audits, in collaboration with Quality Improvement staff as it relates to claims.
+ Evaluates provider compliance with company policies and procedures as well as administrative standards required by regulators.
+ Provides issue resolution and complex trouble shooting skills to providers, acting as the liaison between the company, the Plan, and the provider community, with the goal to reach satisfactory results without the need for client intervention.
+ Supports the Network Department in providing trends reporting and evaluating claims for outlying providers who may have issues or irregular habits as it relates to medical and behavioral claims submission.
+ Conducts and evaluates provider educational activities.
+ Designs and develops provider training and educational materials, and assists in the planning and coordination of provider meetings, seminars, and conferences.
+ Reports activities and results to the Network Department, seeking feedback for future planned outreach.
Other Job Requirements ResponsibilitiesPreferred Qualification
+ Bachelor's Degree in Healthcare
+ Three years of claims experience with CMS or state agency required. An equivalent combination of experience and education will be considered.
+ Proficiency with Microsoft Office.
+ Excellent written and verbal communication skills.
+ Strong organizational skills.
General Job Information Work Experience Claims, MedicareEducation A Combination of Education and Work Experience May Be Considered. (Required), Bachelors: HealthcareLicense and Certifications - Required License and Certifications - Preferred Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.