Senior Claims Processor

Primary City/State:Tucson, ArizonaDepartment Name:Claims ProcessingWork Shift:DayJob Category:FinanceHelp move health care into the future. At Banner Health we are changing health care to make the experience the best it can be. If that sounds like something you want to be part of, apply today.This remote position has a flexible schedule between 6 am - 6 PM Arizona time.This is processing position is mainly for UB (Institutional claims) but could be required to work CMS (Medical Claims) from time to time. This role is also for Arizona Long Term Care AHCCCS plan.Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits.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 SUMMARYThis 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 FUNCTIONSData-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 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.

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

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 QUALIFICATIONSKnowledge, 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 QUALIFICATIONSTwo years of IDX claims system experience preferred.Additional related education and/or experience preferred.EOE/Female/Minority/Disability/Veterans (https://www.bannerhealth.com/careers/eeo)Our organization supports a drug-free work environment.Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy)EOE/Female/Minority/Disability/VeteransBanner Health supports a drug-free work environment.Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability