Details
Posted: 29-Jul-22
Location: Phoenix, Arizona
Salary: Open
Categories:
Operations
Primary City/State:
Phoenix, Arizona
Department Name:
Claims Processing
Work Shift:
Day
Job Category:
Finance
Find your path in health care. We want to change the lives of those in our care ??? and the people who choose to take on this challenge. If you???re ready to change lives, we want to hear from you.??
Claims Department is very fast pace. We work together and help each other out if claims is your specialty come join our team.
"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
The primary purpose of this position is to maintain day-to-day workflow in the Claims Department by timely processing of claims and special projects assigned to the Claims Department.
CORE FUNCTIONS
1. Supervises the claims processing and clerical staff including participating in hiring, development, appraisals, and disciplinary action when necessary.
2. Maintain workflow of Claims Department. Assures that the processing of medical and dental claims meets department production and accuracy standards and remains compliant with AHCCCS filing requirements. Assists with training and development of all Claims Department staff along with Claims Manager and Auditor/Trainer/Level IV processors. Represents Claims Department at meetings as assigned.
3. Manages the Pend Report and overall inventory. Assists processors in resolving aged pended claims. Review and release interface edits from ICES. With Claims Manager and other UAHP Department Managers, coordinates and prioritizes projects consistent with Health Plan needs.
4. Coordinates with UAHN, UMC and all network providers the payment of clams in a timely, efficient manner sharing responsibility for the education of these providers directly and through Network Development.
5. Review daily processor audits, with auditor/trainer, evaluating individual production and accuracy of each claims processor.
6. Provides back up for claims processors to maintain productivity standards and provider backup for processing of specialty claims such as transplants, hemophilia, and home infusion.
7. Perform research on questions regarding discrepancies, contract changes, and other issues impacting claims adjudication. Assist Appeals department and Claims Customer Care Leadership in resolving claims Inquiries.
8. Works closely with Finance, Information Systems and Provider Relations to ensure that effective work processes are maintained for accurate and timely payment of claims.
9. Works independently under limited supervision. Supervises within the function for the company. Has freedom to determine how to best accomplish functions within established procedures.
MINIMUM QUALIFICATIONS
Five years of claims processing experience, strong communication and organizational skills, and proficiency with mathematical concepts, including percentages, decimals, and fractions, and two years experience with IDX Claims System, as is the ability to proficiently use Microsoft Word and Excel including manipulating, analyzing, and researching data
Experience researching and resolving claims issues through projects and Provider meetings is required.
Ability to develop and maintain positive relationships and have the ability to communicate effectively and professionally with providers, other UAHN departments, and all staff.
PREFERRED QUALIFICATIONS
Strong knowledge of AHCCCS regulations, BA/BS preferred. Two years supervisory experience that includes experience in hiring, evaluating, and training employees preferred. CPC and CPC-H coding certification is also preferred
Additional related education and/or experience preferred.
