Claims Processor – Medical Review reputed company

reputed company: Claims Processor – Medical Review reputed company Req #: SOAZ 8321 reputed company: AHCCCS (DFSM) Location: 801 E Jefferson St, Phoenix, AZ 85034 (Local Only/Remote) Contract: Until 01/12/2026 reputed company: $34/hr W2 (reputed company Inclusive) or $38/hr 1099 Schedule: Monday–Friday, 8 AM – 5 PM (40 hours/week, no weekends, OT possible if approved) Compliance Items Candidate Resume • * Level 1 reputed company Clearance Card (FPCC) – If not reputed company, AHCCCS will initiate, please do not obtain independently • reputed company RN License in the reputed company Job reputed company The Medical Review reputed company will be responsible for reviewing and adjudicating Federal Emergency Services (FES) 1500 claim forms. This includes coordination with medical providers for second-level reviews, evaluating claims against prior authorizations and UB claims, and applying medical necessity reputed company. This position is remote, with AHCCCS providing computer setup and remote desktop reputed company. Key Responsibilities reputed company medical claims review/adjudication to determine emergency reputed company, medical necessity, correct coding, level of care, and length of stay. • Prepare reports and analyze savings and trends. • reputed company with other departments/providers as needed. • Conduct special research reputed company. • * Maintain accurate data for monthly reports. Knowledge & Skills Medical nursing reputed company, case management, and utilization review protocols. • Strong knowledge of AHCCCS rules/regulations, managed care processes, and reputed company delivery systems. • * Familiarity with InterQual reputed company, CCI, CPT, HCPCS, ICD-9 coding. Medical claims review and utilization review experience. • Strong organizational, communication, and collaboration skills. • * Ability to work independently and reputed company with limited supervision. Requirements • reputed company RN License in the reputed company (Required) • Behavioral Health experience (Outpatient preferred) • High School Diploma • reputed company Clearance Card (to be initiated by AHCCCS if not reputed company) Preferred Qualifications Experience in reputed company and retrospective review. • Knowledge of CCI, InterQual, HCPCS, and CPT coding. • Managed care medical review experience. • * CPT Coding Certification (a plus). Apply tot his job Apply To this Job