DEPT OF HEALTH SERVICES

The Arizona Department of Health Services promotes and protects the health of Arizona’s children and adults. Our mission is to promote, protect, and improve the health and wellness of individuals and communities in Arizona. We strive to set the standard for personal and community health through direct care, science, public policy, and leadership. ADHS promotes alternative work schedules, flexible hours. We have positions that can fit any stage in your career, from entry to senior level. We offer a robust benefit package, including the ADHS Student Loan Assistance Program, where eligible employees can receive up to $437.50 per month for their outstanding student loans. Come check us out and see how you can make a difference in the lives of all Arizonans.

Medical Payments Recovery Specialist

Job Location:

Address: 501 N 24th St, Phoenix, AZ 85008

Posting Details:

Salary: $55,000 

Grade: 16

Closing Date: 

Job Summary:

This position is responsible for assisting with efforts to ensure that ASH and ACPTC are appropriately maximizing reimbursement for services provided to patients and residents, while at the same time correctly minimizing payments to external medical providers for required services for patients and residents. It requires close attention to detail, the ability to analyze and diligently follow through to completion complicated medical billing situations, and clear communication with medical service providers, insurance companies, patients/residents, and their family/guardians.

Job Duties:

-Searches for and retrieves information from case files, and responds to informational requests requiring some judgment or discretion regarding current and specific business of the work system, as reflected in the records.

-Gathers and compiles information and data regarding assigned cases for use during discussions and negotiations with clients, attorneys, insurance companies, health plans and medical representatives.

-Composes correspondence dealing with subject matter in ways that call for considerable discretion and involve some judgment or negotiation, replying to inquiries, presenting or requesting information.

-Receives recovered funds and deposits with agency's accounting system for deposit in holding account; monitors disbursement of funds as approved.

-Prepares and files liens against all involved parties on behalf of agency pending resolvement of settlement for recovery of medical expenditures; amends and releases liens as approved.

-Researches case files and eligibility status of member; gathers information and data and contacts (phone or letter) representatives of state and county agencies, health care plans and liability insurance companies and attorneys to discuss and negotiate settlements in recovery of funds.

-Compares data from several sources to assure accuracy of report statements, descriptions or phraseology, according to established criteria, and relying upon some knowledge of the subject material.

-Other duties as assigned as related to the position (typically 5% - 10%)

Knowledge, Skills & Abilities (KSAs):

Knowledge of:

- Understanding of medical billing, coding systems and claim forms.
- Knowledge of Medicare, Medicaid, HMOs, PPOs, and private insurance policies.
- Understanding of the full revenue cycle management process, from patient registration to final payment.
- Awareness of HIPAA regulations and billing compliance standards.
- Familiarity with EHR and practice management systems (e.g., myAvatar, Epic, Cerner, NextGen).
- Understanding of how to manage and follow up on unpaid claims and balances.

Skill in:

- Attention to detail, particularly related to accuracy in coding, billing, and entering patient data.
- Ability to identify and resolve claim denials, rejections, and billing discrepancies.
- Clear verbal and written communication with patients, insurance companies, and healthcare providers.
- Ability to explain billing issues to patients and handle inquiries professionally.
- Efficiently prioritize and manage multiple billing tasks and deadlines.

Ability to:

- Work both independently and as part of a team, by autonomously managing individual workload, while coordinating with medical and administrative staff.
- Resolve complex insurance and billing issues creatively and effectively.
- Handle sensitive patient and financial data in compliance with privacy laws.
- Adjust