Healthcare Claims Examiner – AHCCCS Eligibility

Pimasheriff; Tucson (AZ); On-site; USD 31,000 - 42,000; Full time

Job summary

Pima County in Tucson, AZ is seeking a Medical Claims Examiner to assist detainees with AHCCCS applications, verify eligibility, and maintain accurate records. You will analyze data, prepare reports, and support access to healthcare benefits.

On-site position at the Detainee & Crisis Systems unit with emphasis on accuracy and timely processing. The role requires reviewing medical claims, communicating with providers, and ensuring compliance with relevant policies and federal/state regulations.

Qualifications

• Three years of work experience in processing or billing medical claims.
• Two years of work experience with Pima County preparing, processing, or billing medical claims or accounting documentation.

Responsibilities

• Reviews, verifies, and processes medical claims documentation for accuracy, coding and adherence to policies and procedures.
• Researches, verifies, and processes resubmitted and/or problem claims according to and within the guidelines of the contract/agreement.
• Responds to inquiries from medical providers, outside agencies, staff and provides information and resolves problems.
• Conducts pre- and post-payment review of claims for accuracy and adherence to policies and procedures.
• Compiles statistical and operational data and prepares reports regarding claims activity.

Skills

Medical claims processing

Data entry

AHCCCS eligibility

Excel

Communication

Tools

Microsoft Office Suite

Job description

Pima County in Tucson, AZ is seeking a Medical Claims Examiner to assist detainees with AHCCCS applications, verify eligibility, and maintain accurate records. You will analyze data, prepare reports, and support access to healthcare benefits.

On-site position at the Detainee & Crisis Systems unit with emphasis on accuracy and timely processing. The role requires reviewing medical claims, communicating with providers, and ensuring compliance with relevant policies and federal/state regulations.