Medicaid & Medicare Claims Educator

Phoenix AZ 85034

Job Description

Ensures providers and prescribers are aware of health plan policy and requirements for claims submissions and/or PA requests. Conducts outbound calls and visits to prescribers or pharmacy providers who need assistance, or for proactive out reach. Travel may be required and varies by client. Additional responsibilities include reporting, letter preparation, and other duties to assist the network department in providing support to the client.
  • Supports provider outreach for planned operational activities through letter preparation, tracking and education. 
  • Supports outcomes reporting for various projects. 
  • Serves as the health plan`s representative in the field in partnership with Network to effectively communicate with providers about company policies, procedures, contractual requirements, regulators requirements and other issues related to claims. 
  • Conducts provider site visits and audits,  in collaboration with Quality Improvement staff as it relates to claims. 
  • Evaluates provider compliance with company policies and procedures as well as administrative standards required by regulators. 
  • Provides issue resolution and complex trouble shooting skills to providers, acting as the liaison between the company, the Plan, and the provider community, with the goal to reach satisfactory results without the need for client intervention. 
  • Supports the Network Department  in providing trends reporting and evaluating claims for outlying providers who may have issues or irregular habits as it relates to medical and behavioral claims submission. 
  • Conducts and evaluates provider educational activities. 
  • Designs and develops provider training and educational materials, and assists in the planning and coordination of provider meetings, seminars, and conferences. 
  • Reports activities and results to the Network Department, seeking feedback for future planned outreach. 

General Job Information


Medicaid & Medicare Claims Educator



Job Family

Clinical Services Group


United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date


Date Requisition Created


Work Experience

Claims, Medicare


A Combination of Education and Work Experience May Be Considered. (Required), Bachelors: Healthcare

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements


Preferred Qualification

  • Bachelor's Degree in Healthcare

Required Qualifications

  • Three years of claims experience with CMS or state agency required. An equivalent combination of experience and education will be considered. 
  • Proficiency with Microsoft Office. 
  • Excellent written and verbal communication skills. 
  • Strong organizational skills. 

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”