Expected Reimbursement Associate

Primary City/State:

Phoenix, Arizona

Department Name:

Managed Care-Analytics

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 work options. If you're looking to leverage your abilities - you belong at Banner Health.

As an Expected Reimbursement Associate, your day will include working independently with some tasks done in collaboration with other teammates. Approximately 20% of working time is spent attending/leading MicroSoft Teams meetings. Primary responsibilities include ensuring calculation accuracy of the contract management systems, performing payer contract audits, ADHOC reimbursement research products, and creating tickets and communicating with contract management vendor. You may also create or analyze reports, gather and compile data from multiple systems, and attend/facilitate meetings with other internal departments.Primary applications used in this role are: FinThrive Contract Management, MS Office (Excel, Word, Outlook) SharePoint, OneNote, NextGen. Knowledge of physician billing, general understanding of fee schedules, provider specialties and managed care contracts (ex: Aetna, Cigna, United,) experience with more advanced functions of MS Excel including pivot tables, VLOOKUPS are helpful. Hours are flexible between the hours of 7AM-5PM after training is complete.

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 is responsible for writing and implementing region-wide policies and procedures as needed when identified through contract and government payer changes. Changes must be reflected properly in the system to ensure accurate billing. This position also provides support for the expected reimbursement process via education to all facilities and data system support.

CORE FUNCTIONS

1. Develops and communicates policies and procedures pertaining to changes for contract and government payers. This would include information received from the payers, pricing master revisions and changes resulting from operations, charge reviews, audits, and patient account denials.

2. Provides timely contract and government payer changes/information to facility personnel across the region. Ensure the necessary changes have been coordinated with information technology.

3. Provides the educational tools and facilitate education sessions needed for facilities to comply with contract and government payer changes.

4. Develops and maintains the contract modeling software system. This would involve interpreting and entering into the contract modeling system all contract rules and payment terms for all the various third part payers. The rules and specific payment terms would be those negotiated and updated by the managed care department so that the organization receives the proper payment from all third party payers.

5. This position manages multiple complex contracts across the region often requiring research as well as involving multiple facilities. Has freedom to determine how to best accomplish functions within established procedures. Confers with supervisor in any unusual situations. This position interacts with various departments across the region.

MINIMUM QUALIFICATIONS

Requires a Bachelor's degree or equivalent experience in finance, healthcare or related field.

Must possess a strong knowledge of healthcare patient billing typically achieved with two to four years healthcare patient billing experience and experience with healthcare data systems, or a combination of education and experience. Must have technical computer knowledge of the reimbursement data systems as well as knowledge of the company's patient account process.

Must possess the ability to interpret policy and procedures. Must have excellent organizational and communication skills as well as the ability to maintain highly confidential data and demonstrate an understanding of contracts.

PREFERRED QUALIFICATIONS

Additional related education and/or experience preferred.

EOE/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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