Great careers start with great training. The people of Banner Health are focused on delivering excellent care to our patients. In return, we are committed to excellence in personal development for all our team members. Apply today.
Self driven department with opportunity to not only learn but identify and trend claims issues. You will get to learn a little about almost all operational aspects. Great opportunity to learn and grow within Banner.
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.
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 reviews all claims disputes for all product lines handled by Health Plan and to determine whether the claim should be reprocessed or the denial upheld. Responsible for meeting all contractual timeliness guidelines and maintaining the necessary logs for reporting purposes. Tracks and trends claim disputes and participates in process improvements to reduce the number of claim disputes received.
CORE FUNCTIONS 1. Reviews all claims deputes for all product lines and determines the proper disposition of each dispute based on contract and benefit standards and meets all contractual requirements.
2. Maintains all claims disputes logs and produce claims disputes reports.
3. Attends all grievance and appeals committee meetings and participates in process improvements centered on claims disputes.
4. Provides education and/or training as requested; collaborates with and support other departments in reducing number of claims disputes.
6. Performs weekly self-audits to ensure compliance with regulatory and contractual requirements.
7. Consistently participates in continuing education programs, classes and/or certifications to remain current with updates/changes/additions to regulatory requirements.
8. Works independently under general supervision using structured work procedures. Makes judgments within a defined framework; coordinates review of claims disputes with other staff members and other departments.
Knowledge, skills and abilities as normally obtained through the completion of a bachelor's degree in in Business or related field and experience in claims processing and/or billing.
Exceptional customer service skills and experience with and knowledge of AHCCCS, HCG and CMS rules and regulations. Knowledge of how to process all claim types and product lines; MS Excel experience required.
Strong presentation, time management, organizational, mathematical, analytical and critical-thinking skills. Exceptional written and oral communication skills and the ability to work cross functionally across the organization and the ability to create, develop and present training sessions.
Certified Coder and Contracting 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.