The future is full of possibilities. At Banner Health, we're excited about what the future holds for health care. That's why we're changing the industry to make the experience the best it can be. If you're ready to change lives, we want to hear from you.
Collaborative Team, working together to reach common goal with open and honest communication. Accountable for performing system testing for upgrades/corrections. Researching issue and to have the ability to view stats regarding claims payment against contract compensation for accuracy and correction. . Prioritizing and the ability to reprioritize daily functions to ensure the department and Health Plan goals are met in regards to claim processing and payment structure.
Your pay and benefits are important components of your journey at Banner Health. Banner Health offers a variety of benefits to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.
Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
POSITION SUMMARY This position, under general direction, will provide support to the claims department leadership team, trainer/auditors and systems team to ensure the department's compliance goals are met.
CORE FUNCTIONS 1. Data-enters and adjudicates internal and external claims on a timely basis in accordance with departmental policies, procedures and standards. Reviews and determines appropriate coding guidelines.
2. Researches resubmitted or corrected claims and pend appropriately. Adheres to governmental guidelines for processing claims.
3. Coordinates with supervisor to resolve high profile claims issues. Enters Siebel requests for provider updates, medical review, enrollment review, and coding review. Trouble shoots, identifies, and resolves special handling requirements related to pricing, contracting, and system issues. Processes CMS 1500 and/or UB04 claims.
4. Assists Claims Systems team and HPIS with testing claims in IDX for system updates and enhancements. Collaborates with Claims Trainer to provide supporting documentation to answer processor's questions as related to CMS and UB04 claim processing and assist with creating desktop procedures. Participates in joint operation committee meetings as needed.
5. Handles high level projects as assigned by management. Coordinates and submits projects to the Claims Systems team that can be reprocessed by auto adjudicating the claims through an electronic process in IDX. Monitors and reports status of special projects to the Supervisor, Manager, or Director. Serves as liaison between departments such as Network Development, Medical Management, Finance and IS to research and rework projects submitted.
6. Reviews and reprocess claims disputes as assigned as well as collaborate with Grievance and Appeals department. Collaborates with high-profile providers to work through and resolve claims issues. Researches and/or reprocesses special, high profile, expedited projects from Grievance and Appeals, finance and Network Development.
7. Participates in iCES review meetings to provide claims processing input needed to enhance the claims adjudication process. Works in conjunction with Encounters and Reinsurance to reprocess claims and identify claims processing issues to assist in providing additional front-end training.
8. Acts as a preceptor for techniques to enhance efficiencies
9. This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at all levels throughout the organization.
Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
Knowledge, skills and abilities typically obtained through two years of medical billing or claims processing experience or proven ability to be successful in this position. Knowledge of CPT-4, ICD-9, and HCPCS codes, and CMS 1500 and/or UB04 forms. Good interpersonal skills, strong decision making skills. Knowledge of Health Plan policies and/or AHCCCS regulations and IDX system. Ability to meet minimum production standards, research and process complex claims.
Ability to assist with high-level claims projects. Demonstrates willingness and initiative in learning new processes and techniques to ensure daily tasks and goals are met, and possesses leadership qualities.
Knowledge of AHCCCS, Commercial and Medicare rules and regulations required. Working knowledge of all claim form types to include 1500 professional forms and UB facility forms. Demonstrates willingness and initiative in learning new processes and techniques to ensure daily tasks and goals are met.
Two years of IDX claims system experience preferred.
Additional related education and/or experience preferred.
What might draw you to Banner Health? A great health care career, of course—and a great place to live, no matter what stage of life you’re in. With facilities across the West, there is a health care career for everyone, from big city living in the Phoenix area to friendly small towns in the mountains and plains. As one of the largest nonprofit health systems in the country, Banner Health offers both the stability that comes with success and the possibility of exploring new areas of the country. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages:
Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health.
Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible.
The size, success and growth of our system provide you with the stability and options to pursue your desired career path.
Competitive compensation and comprehensive benefits offer you options to complement your unique needs.