The primary purpose of this position is to maintain day-to-day workflow in the Claims Department by timely processing of claims and special projects assigned to the Claims Department.
Supervises the claims processing and clerical staff including participating in hiring, development, appraisals, and disciplinary action when necessary.
Maintain workflow of Claims Department. Assures that the processing of medical and dental claims meets department production and accuracy standards and remains compliant with AHCCCS filing requirements. Assists with training and development of all Claims Department staff along with Claims Manager and Auditor/Trainer/Level IV processors. Represents Claims Department at meetings as assigned.
Manages the Pend Report and overall inventory. Assists processors in resolving aged pended claims. Review and release interface edits from ICES. With Claims Manager and other UAHP Department Managers, coordinates and prioritizes projects consistent with Health Plan needs.
Coordinates with UAHN, UMC and all network providers the payment of clams in a timely, efficient manner sharing responsibility for the education of these providers directly and through Network Development.
Review daily processor audits, with auditor/trainer, evaluating individual production and accuracy of each claims processor.
Provides back up for claims processors to maintain productivity standards and provider backup for processing of specialty claims such as transplants, hemophilia, and home infusion.
Perform research on questions regarding discrepancies, contract changes, and other issues impacting claims adjudication. Assist Appeals department and Claims Customer Care Leadership in resolving claims Inquiries.
Works closely with Finance, Information Systems and Provider Relations to ensure that effective work processes are maintained for accurate and timely payment of claims.
Five years of claims processing experience, strong communication and organizational skills, and proficiency with mathematical concepts, including percentages, decimals, and fractions, and two years experience with IDX Claims System, as is the ability to proficiently use Microsoft Word and Excel including manipulating, analyzing, and researching data
Experience researching and resolving claims issues through projects and Provider meetings is required.
Ability to develop and maintain positive relationships and have the ability to communicate effectively and professionally with providers, other UAHN departments, and all staff.
Strong knowledge of AHCCCS regulations, BA/BS preferred. Two years supervisory experience that includes experience in hiring, evaluating, and training employees preferred. CPC and CPC-H coding certification is also preferred
Additional related education and/or experience preferred.
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.