Medical Claims Examiner - Detainee & Crisis Systems

Pima County Government • Contract • Tucson, AZ, US • $22 - $29 / hour • 6d ago

This job was posted by https://www.azjobconnection.gov : For more

information, please see: https://www.azjobconnection.gov/jobs/7348572

# **Job Description Summary**

Department - Detainee & Crisis Systems

# **Job Description**

**OPEN UNTILFILLED**

**Job Type: Classified**

**Job Classification: 5740 - Medical Claims Examiner**

**Salary Grade:7**

**Pay Range**

**Hiring Range: \$22.18 - \$26.05 Per Hour**

**Pay Range: \$22.18 - \$29.92 Per Hour**

Range Explanation

Hiring Range is an estimate of where you can receive an offer. The

actual salary offer will carefully consider a wide range of factors,

Including Your Skills, Qualifications, Experience, Education,

licenses, training, and internal equity.

Pay Range is the entire compensation range for the position.
The first review of applications will be on 02/20/2026*****.**

The Medical Claims Examiner administers and processes medical claims for

Pima County, ensuring compliance with relevant regulations and

contractual agreements. Utilizes specialized knowledge in healthcare

coding and claims management to research and resolve complex claims

issues. Provides essential support to medical providers and departmental

staff by offering guidance on claims procedures and policies. Actively

participates in the development and adjustment of claims processing

guidelines to maintain accuracy and efficiency in accordance with

federal and state mandates and County policies. Engages in comprehensive

data analysis to monitor trends and improve claims processing systems.

Essential Functions

As defined under the Americans with Disabilities Act, this

classification may include any of the following tasks, knowledge,

skills, and other characteristics. This list is ILLUSTRATIVE ONLY and is

not a comprehensive listing of all functions and tasks performed by

incumbents of this class. Work assignments may vary depending on the

department\'s need and will be communicated to the applicant or

incumbent by the supervisor.

Reviews, verifies, and processes medical claims documentation for

accuracy, coding and adherence to policies and procedures and rules

and regulations;

Researches, verifies, and processes resubmitted and/or problem

claims according to and within the guidelines of the

contract/agreement and in compliance with applicable federal and

state statutes and regulations and County and department (e.g.,

HCFA, AHCCCS, OMS, Health) policies;

Researches, verifies, and makes adjustments to claims and/or

authorizes or denies claims in accordance with and within the

guidelines of the contract/agreement, and in compliance with

applicable Federal and State statutes and regulations and County and

department policies and procedures;

Responds to inquiries made by medical providers, outside agencies,

staff and provides information and resolves problems which require

explanation of County, departmental, or program rules and policies

or refers questions to appropriate staff;

Conducts pre- and post-payment review of claims for accuracy and

adherence to policies and procedures;

Participates in the evaluation of new contractual guidelines by

conducting testing to ensure that claims may be processed accurately

and in a timely manner, in accordance to and within the guidelines

of the new contract/agreement, and in compliance with applicable

federal and state statutes and regulations and County and department

policies and procedures;

Participates in the development of new unit operating procedures

and/or reviews and makes recommendations or changes to existing unit

policies and procedures;

Compiles statistical and operational data, to include trends, and

prepares periodic, narrative, and special reports regarding claims

activity;

Processes payments for medical claims and resolves any discrepancies

with departments and/or outside agencies in compliance with

applicable federal and state statutes and regulations and County and

department (e.g., HCFA, AHCCCS, OMS, Health) policies;

Reviews, verifies, logs and stamps medical claim documentation

submitted by a department and/or outside agency for accuracy,

validity, coding and adherence to rules, policies and procedures and

regulations;

Interprets and enters information from a variety of source documents

(e.g., medical records, insurance information, EOBs, CMS 1500s,

Dental, and UB-04s) into a database system and adjudicates.

Minimum Qualifications