Claims Processor

Primary City/State:
Arizona, Arizona

Department Name:
Claims Processing

Work Shift:
Day

Job Category:
Finance

Great careers are built at Banner. We understand that talented professionals appreciate having options. We are proud to offer our team members many career and lifestyle choices including remote & hybrid work options. Apply today.

Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities.

As a Claims Processor you will work call upon your Medical Billing and Claims Processing experience. Working individually and as part of a larger team you will process claims utilizing decision tools, you will follow up on reporting action items, and answer customer service tickets.

Your work location will be entirely remote. Your work shifts will be Monday-Friday following day shift hours in the Arizona Time Zone. 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.

2. Researches resubmitted or corrected claims and pend appropriately. Adheres to governmental guidelines for processing claims.

3. Refers fee schedule, vendor contract, plan problems or concerns to manager or senior level processors for intervention. 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. 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.

PREFERRED QUALIFICATIONS

Two years of IDX claims system experience preferred.

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