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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 is the second level of the claims processing career ladder. The position audits professional and facility claims post payment utilizing tool for random audit of processor output for the full range of company insurance products. The work includes responsibilities such as processor and system accuracy, financial and procedural, interest application if any and timeliness. Tracking of claims audits by completion of spreadsheet for weekly data reporting and monthly compliance and regulatory dashboards. Audits consist of 3% of claims processed daily identifying issue and work with team, and supervisors on identification of root issue and correction.
1. Conducts post payment audits to verify claim processing accuracy by review of professional and facility claim payment.
2. Conducts audit on all high dollar claims pre-release for payment to verify accuracy of claim processing. Claims are identified by payment amount of which require a pre-audit
3. Provides timely and accurate information to supervisors regarding post payment audit(s) utilizing the reporting documents in place.
4. Works independently as well as a strong team member for consistency in claim auditing guidelines and to identify if error is a global issue or a single processor error using structured work procedures. Makes judgments within a defined framework.
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.
High school diploma/GED or equivalent working knowledge.
The knowledge of medical claims typically acquired over two to three years of work experience in medical claims adjudication. Must also have thorough understanding and knowledge of the UB92 and HCFA 1500 forms, medical procedure terminology, contract interpretation and knowledge of CPT, HCPCS and ICD-9 coding and how they apply to claims adjudication. Must possess a working knowledge of Medicare, Medicaid, and self-funded insurance, coding rules and coverage guidelines based on the Medicare and HCFA rules and regulations. A complete understanding of the coordination of benefits functions to ensure proper payments or recovery of funds is required.
Requires the ability to work effectively with common office software, and to use effective oral and written communication, team working customer service skills.
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.