Remote Claims Clinical Documentation Reviewer

State of Arizona

Phoenix (AZ)

Remote

USD 68,000 - 71,000

Full time

47 hours ago

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Benefits offered by this job

Remote work options

Paid holidays

Public Transit Subsidy

Job summary

AHCCCS, Arizona’s Medicaid agency, is seeking a Claims Clinical Documentation Reviewer in the Division of Fee for Service (DFSM). This role reviews clinical documentation to support billed Medicaid services, using PMMIS and healthcare regulations, with potential for telecommute or VO.

The position requires clinical experience, knowledge of Medicaid/Medicare rules, and strong analytical skills. It offers salary $68,000–$71,032 and a remote-work option within the State of Arizona.

Qualifications

Two to three years clinical and programmatic experience in behavioral health or related field.
Quality Management and/or Compliance Certification within behavioral health preferred or AZ licensed nurse / independent license.
Familiarity with Medicaid/Medicare regulations and AHCCCS policies.

Responsibilities

Conduct pre-payment reviews for medical necessity and billing accuracy.
Process reviews using PMMIS and related AHCCCS systems.
Participate in trainings, huddle boards and cross-functional meetings.
Review clinical documentation to support approved or denied claims.
Assist in provider on-site reviews and team collaborations.

Skills

Service Authorization concepts

Behavioral health knowledge

Healthcare regulations

PMMIS familiarity

Strong communication

Tools

PMMIS

EHR / HIE

Microsoft Suite

Google Suite

Job description

The position requires clinical experience, knowledge of Medicaid/Medicare rules, and strong analytical skills. It offers salary $68,000–$71,032 and a remote-work option within the State of Arizona.

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