Regional Claims Resolution Specialist (Hybrid)

Arizona Priority Care; Chandler (AZ); On-site; USD 32,000 - 36,000; Full time

Job summary

Arizona Priority Care in Chandler, AZ seeks a Medical Claims Resolution Coordinator to research and resolve provider disputes, escalated claims inquiries, and claims projects compliant with government and Health Plan regulations. You will analyze root causes, ensure timely payment decisions, and support system/configuration updates.

The role requires strong knowledge of Medicare Billing guidelines, CPT/HCPCS/ICD-10 codes, and experience with both professional and facility claims.

Qualifications

• Two years claims processing experience required.
• Knowledge of Medicare rules, CPT, ICD-10 and RSV codes.
• Familiar with professional and facility claims processing.
• Ability to work independently and meet deadlines.

Responsibilities

• Review disputes within AZPC, DOHC & Medicare policy guidelines.
• Request additional information promptly to resolve claims.
• Ensure payment or denial within policy deadlines.
• Maintain and update the PDR log and related documentation.
• Educate providers on proper submission of appeals and processes.

Skills

Attention to detail

Effective communication

Independent worker

Multitasking

Education

High school diploma or GED

Tools

EZ-Cap

Job description

Arizona Priority Care in Chandler, AZ seeks a Medical Claims Resolution Coordinator to research and resolve provider disputes, escalated claims inquiries, and claims projects compliant with government and Health Plan regulations. You will analyze root causes, ensure timely payment decisions, and support system/configuration updates.

The role requires strong knowledge of Medicare Billing guidelines, CPT/HCPCS/ICD-10 codes, and experience with both professional and facility claims.