Senior Claims Processor Remote

Primary City/State:

Arizona, Arizona

Department Name:

Claims Processing

Work Shift:

Day

Job Category:

Finance

Find your path in health care. At Banner Health, caring for people is at the core of all we do. We are committed to diversity, equity and inclusion. If that sounds like something you want to be a part of - apply today!

Banner Health has been recognized by Becker’s Healthcare as one of the 150 top places to work in health care. In addition, we recently made Newsweek’s list of America’s Greatest Workplaces 2023 for Diversity. These recognitions reflect Banner Health's investment in team members' professional development, wellness benefits, and continued education. It highlights our commitment to advocating for diversity in the workplace, promoting work-life balance, and boosting employee engagement.

As a Senior Claims Processor, you will utilize your claims processing and billing experience to be an important member of a highly collaborative Claims Team. As a member of this team, you will review claims to determine the root cause of provider issues received from other departments. You will share information regarding projects with the entire team so that all members have awareness and can learn from a variety of claims projects.

Your work schedule will be Monday-Friday with the possibility for some flexibility of hours between 6:00 a.m. and 5:30 p.m. AZ Time Zone. This role will be entirely remote. If this role sounds like the one for you, Apply Today!

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, under general direction, will provide support to the claims department leadership team, trainer/auditors and systems team to ensure the department’s compliance goals are met.
CORE FUNCTIONS
1. 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.
2. Researches resubmitted or corrected claims and pend appropriately. Adheres to governmental guidelines for processing claims.
3. 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.
4. 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 processor’s questions as related to CMS and UB04 claim processing and assist with creating desktop procedures. Participates in joint operation committee meetings as needed.
5. 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.
6. 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.
7. 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.
8. Acts as a preceptor for techniques to enhance efficiencies
9. This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at all levels throughout the organization.
MINIMUM QUALIFICATIONS
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.
PREFERRED QUALIFICATIONS

Two years of IDX claims system experience preferred.
Additional related education and/or experience preferred.

EOE/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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