Good health care is key to a good life. At Banner Health, we understand that, and that's why we work hard every day to make a difference in people's lives. Do you like the idea of making a positive change in people's lives - and your own? If so, this could be the perfect opportunity for you.
As a Claims Adjuster here at Banner we offer a exciting, challenging, rewarding position of adjudicating claims for the State of Arizona health plans
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 processes corrections to claims accurately and in a timely manner. Assists with claim inquiries while maintaining production and quality standards in accordance with department processing standards of monitoring back outs greater than one year.
CORE FUNCTIONS 1. Performs detailed research and reprocessing of AHCCCS, Medicare (Special Needs Plan) and commercial claims using a back out function in IDX. The back out function takes the original claim and produces a replacement claim number. The claim is reprocessed on the replacement claims according to the nature of the request.
2. Reviews and reprocesses AHCCCS, Medicare, and Commercial Provider requests via Customer Care Calls.
3. Trouble shoots, identifies, and resolves special handling requirements related to pricing, contracting, and system issues.
4. Serves as liaison with between departments such as Network Development, Medical Management, Finance and IS to research and rework projects submitted.
5. Reviews and reports all types of claims that are reprocessed into the claims adjustment database. Information is used to identify trends and to implement front end processes that will reduce rework.
6. Coordinates and submits projects to the Claims Systems team that can be reprocessed by auto adjudicating the claims through an electronic process in IDX.
7. Researches and/or reprocesses special, high profile, expedited projects from Grievance and Appeals, finance and Network Development.
8. Organizes workload to complete assignments, working with minimum supervision. Serves as liaison with external departments when needed to work thru projects. Maintains control of recoupments in excess of 50K per provider. Participates in joint operation committee meetings as needed.
Knowledge, skills and abilities as normally obtained through two years of experience in medical billing. Knowledge of Health Plan policies, AHCCCS, Commercial and Medicare rules and regulations, IDX system. Knowledge of CPT-4, ICD-9, and HCPCS codes and knowledge of CMS 1500 and/or UB04 forms.
Requires good interpersonal skills and strong decision making and organizational skills. Excellent customer service skills, strong analytical, and written and verbal communication skills required. Ability to work and prioritize multiple tasks and to use Microsoft Word and Excel required. Working knowledge of all claim form types to include 1500 professional forms and UB facility forms.
Two years of experience processing claims with IDX platform.
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.