Management Analyst

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.

Lead Medical Billing & Coding Specialist

Job Location:

150 N 18th Ave., Phoenix, AZ 85007

• Salary: $57,200
• Grade: 21

This position is responsible for the supervision and evaluation of data processing and data quality assurance activities for the Federally funded National Breast and Cervical Cancer Screening Program (NBCCEDP) through the Well Woman Health Check Program (WWHP). The position is responsible for supervising data processes and conducting continuous quality improvement (CQI) to ensure optimal performance, data integrity, and efficiency. The position will lead and conduct data quality analyses routinely, present recommendations to management, provide technical assistance or consultation, and coordinate process improvements and systems implementation.

This position will develop or update data entry manuals outlining established methods of performing work, provide quality control for all data entered in CaST, and provide training and support to other data analysts. Lastly, they will ensure data entry error rate is at or below .01%, respond to questions and concerns from other data analysts, lead weekly huddles, and present at quarterly meetings with contractors.

Additionally, the position will do the following:

• Review assigned codes to diagnoses and procedures, using program approved CPT (Current Procedural Terminology) codes
• Ensure codes are accurate and sequenced correctly in accordance with NBCCEDP and Medicare regulations
• Follow up with the clinic coordinators on any documentation that is insufficient or unclear
• Communicate with other contracted clinical staff regarding documentation
• Search for information in cases where the coding is complex or unusual
• Review patient records and patient listing spreadsheet for accuracy
• Participate in quality assurance and utilization review as needed
• Provide ongoing train of new team members via google meet & in person to include designing and coordinating onboarding training packet, SOW, CPT code, CaST guidance manual etc.
• Provide Quality Control for the review and data entry process

Review and audit claims submitted by contractor participating in the Well Woman Health Check Program (WWHP). Reviews patient medical record/documentation submitted for accuracy and analyzes work processes and makes recommendations for process improvement. Serve as designated quality control personnel for the WWHP.

Investigate medical procedure codes billed to ensure compliance with NBCCEDP Policy and procedures and the State of Arizona WWHP Scope of Work. Conduct effectiveness reviews to ensure only program approved codes are used and communicate effectively with providers and other clinical staff regarding insufficient or unclear documentation.

Deny/Approve or correct codes based on medical documentation provided. Engage contractors for clarification, missing documentation. Develop or update functional or operational manuals outlining established methods of performing work in accordance with WWHP policy.

Ensure codes are accurate and sequenced correctly. Research coding for complex or unusual cases. Troubleshoot difficult cases and coding scenarios with WWHP Program Manager, Cancer Program Administrator and Epidemiologist for best decision making.

Ensure accuracy in data entry and review process by conducting daily continuous quality improvement (CQI) of data entry…