Under general direction this position will provide support to the claims department leadership team, trainer/auditors and systems team to ensure the departments compliance goals are met.
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.
Researches resubmitted or corrected claims and pend appropriately. Adheres to governmental guidelines for processing claims.
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.
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 processors questions as related to CMS and UB04 claim processing and assist with creating desktop procedures. Participates in joint operation committee meetings as needed.
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.
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.
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.
Acts as a preceptor for techniques to enhance efficiencies
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.
Internal Number: 268663
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •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 system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •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. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.