Primary City/State:

Arizona, Arizona

Department Name:

Claims Processing

Work Shift:

Day

Job Category:

Finance

A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote & hybrid work options. If you’re looking to leverage your abilities – you belong at Banner.

Banner Plans & Networks (BPN) is an integrated network for Medicare and private health plans. Known nationally as an innovative leader, BPN insurance plans and physicians work collaboratively to keep members in optimal health while reducing costs. Supporting our members and vast network of providers is a team of professionals known for innovation, collaboration, and teamwork. If you would like to contribute to this leading-edge work, we invite you to bring your experience and skills to BPN. Production and quality expectations must be met for you to be successful in this role.

As a Claims Adjuster for Banner Plans & Networks, you will process both Professional and Institutional claims. You will process Resubmission Claims, Provider Appeals received from the Grievance and Appeals Department, Requests to Recoup, and Claim Review Service Requests. You will become the "subject matter experts" for all claims that come through our inventory request. Therefore, two years of claims processing experience is required for this role.

Your work location will be entirely remote. Your work shifts will be Monday-Friday primarily working in Arizona Time Zone business hours. 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 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.

MINIMUM QUALIFICATIONS

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.

PREFERRED QUALIFICATIONS

Two years of experience processing claims with IDX platform.

Additional related education and/or experience preferred.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

Privacy Policy:

Privacy Policy