The primary purpose of the position is to manage the operations of the Claims Department to ensure accurate and timely claims payment. This position will support the encounters and reinsurance teams as needed. This position performs in a manner that is consistent with and in support of the organizations mission, vision, values and goals.
Manages claims operations to ensure quality service, accurate and timely claims payment is achieved and consistently maintained.
Monitors inventory/backlog, performance management, production standards and quality of results in aspects of claims adjudication, reprocessing, reconciliations and audits.
Attends provider joint operation committees. Participates in all appropriate team and task forces meetings and workgroups.
Problem solves difficult claims issues, creating solid resolutions including dealing with sensitive subjects.
Works with Compliance, Clinical Services, HP IS, Network Development, as necessary, to ensure accurate, timely payment of claims.
Hires, develops, mentors staff in all aspects of claim processing, and orients staff to overall health plan operations. Establishes standards, develops incentive plans and manages performance of Claims Department staff.
Maintains personal continuing education as appropriate to keep current on all aspects of claims processing. Educations maybe through AHCCCS correspondence, meetings, internet sites, as well as other professional publications and education meetings as necessary.
Prepares and monitors annual operating budget for Claims Operations Department. Responsible for operating within projected annual budget. Make recommendations for staffing levels, salaries, promotions, as well as operating and capital needs to ensure a fully functioning department.
Knowledge, skills and abilities as normally obtained through the completion of a bachelors degree or equivalent combination of work experience and/or education in health care administration/management and/or finance administration or related field. Two to Five years healthcare claims or customer care experience or any combination of the two. Two years of experience in staff training, development and process, and the ability to manage operations to ensure regulatory compliance standards
Excellent written and verbal communication skills; knowledge of Medicaid/Medicare billing rules, CPT-4, ICD-9, and HCPCS codes, and CMS 1500 and/or UB04 forms. Good interpersonal and strong decision making skills. Strong organizational skills with the ability to work and prioritize multiple tasks. Knowledge of Health Plan policies and AHCCCS regulation.Knowledge of IDX system and knowledge of AHCCCS, Commercial and Medicare rules and regulations.
Working knowledge of all claim form types to include 1500 professional forms and UB facility forms. Excellent customer service skills, both internal and external. Strong written and verbal communication skills. Ability to use Microsoft Word and Excel required and ability to supervise fifteen or more employees, from entry level to supervisory level personnel.
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.