What are the responsibilities and job description for the Senior Claims Examiner position at Banner Health?
Department Name:
Claims Processing
Work Shift:
Day
Job Category:
Finance
The future is full of possibilities. At Banner Health, we’re excited about what the future holds for health care. That’s why we’re changing the industry to make the experience the best it can be. If you’re ready to change lives, we want to hear from you.
Highly motivated, high functioning team that like to win and be ahead of the game!
As a Senior Claims Examiner you will spend most of your day researching claims — auditing them for accuracy, compliance, and correct payment. You’ll manage escalated and complex claims issues, working closely with internal departments for reconsiderations, refunds and payment disputes. A big part of the role is reviewing emails for encounters, outside vendors, and special projects, while keeping everything moving on time across Medicare plans. You’ll also create reports to track trends and quality opportunities, support mass adjustment efforts, and act as a go-to subject matter expert when tricky claim questions come up. Overall, you’ll work independently within defined processes while providing strong leadership, accuracy, and great service every step of the way.
This is a remote position is only for applicants who reside in the following states: Arizona (AZ), California (CA), Colorado (CO), Nebraska (NE), Nevada (NV), and Wyoming (WY). The work schedule is set for Monday to Friday, 8 hour shifts. If this opportunity resonates with you, we encourage you to apply today!
Banner Plans & Networks (BPN) 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 BPN, 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 audits all claims for proper adjudication while handling special projects, reconsiderations, refunds and void processes. The incumbent will maintain proper record keeping of all support files and be responsible for providing in-service to appropriate personnel with regard to changes and updates in claims processing guidelines for the Banner and Risk Plans. This position may also be responsible for resolution of issues received from internal/external clients to include Customer Service, Provider Relations, Networks, Finance, Medical Management, etc.
Core Functions
High school diploma/GED or equivalent working knowledge.
A minimum of three to four years experience in Medical and/or Dental claims adjudication in an automated environment. Must have an excellent understanding of medical terminology, contract and benefit interpretation, CPT, HCPCS and ICD-9/ICD-10 coding with a working knowledge of Medicare, AHCCCS, Self-funded and/or commercial insurance plans.
Must possess strong oral and written communication skills including effective interpersonal skills and attention to detail and accuracy.
Preferred Qualifications
Previous claims auditing experience is preferred, Associates degree in related field.
Additional Related Education And/or Experience Preferred.
DATE APPROVED 10/29/2015
Estimated Pay Range:
$21.01 - $31.51 / hour Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.
EEO Statement:
EEO/Disabled/Veterans
Our organization supports a drug-free work environment.
Privacy Policy:
Privacy Policy
Claims Processing
Work Shift:
Day
Job Category:
Finance
The future is full of possibilities. At Banner Health, we’re excited about what the future holds for health care. That’s why we’re changing the industry to make the experience the best it can be. If you’re ready to change lives, we want to hear from you.
Highly motivated, high functioning team that like to win and be ahead of the game!
As a Senior Claims Examiner you will spend most of your day researching claims — auditing them for accuracy, compliance, and correct payment. You’ll manage escalated and complex claims issues, working closely with internal departments for reconsiderations, refunds and payment disputes. A big part of the role is reviewing emails for encounters, outside vendors, and special projects, while keeping everything moving on time across Medicare plans. You’ll also create reports to track trends and quality opportunities, support mass adjustment efforts, and act as a go-to subject matter expert when tricky claim questions come up. Overall, you’ll work independently within defined processes while providing strong leadership, accuracy, and great service every step of the way.
This is a remote position is only for applicants who reside in the following states: Arizona (AZ), California (CA), Colorado (CO), Nebraska (NE), Nevada (NV), and Wyoming (WY). The work schedule is set for Monday to Friday, 8 hour shifts. If this opportunity resonates with you, we encourage you to apply today!
Banner Plans & Networks (BPN) 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 BPN, 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 audits all claims for proper adjudication while handling special projects, reconsiderations, refunds and void processes. The incumbent will maintain proper record keeping of all support files and be responsible for providing in-service to appropriate personnel with regard to changes and updates in claims processing guidelines for the Banner and Risk Plans. This position may also be responsible for resolution of issues received from internal/external clients to include Customer Service, Provider Relations, Networks, Finance, Medical Management, etc.
Core Functions
- Audits claims for accuracy of the data, payments, contract interpretation and compliance within established polices and procedures. Researches and processes adjustments for reconsiderations, refunds, voids, and special projects.
- Selects claims though random process to conduct audits to ensure compliance standards is met. Supports and assists with mass adjustment projects.
- Manages the claims administration workflow in a timely and accurate manner necessary to meet Plan requirements associated with the company Health, Risk and Dental Plan benefit process and/or requirements associated with AHCCCS, Medicare, and Commercial.
- Acts as the primary claims resolution specialist for internal and external clients related to escalated claims issues and for claims adjudication and handling of difficult claims issues.
- Provides information to providers/members and maintains system information as necessary for internal and external auditing purposes.
- Develops and creates reports necessary to track, trend and monitor for training and quality purposes, and workflow efficiencies.
- Works independently under regular supervision. Works within defined processes. Provides leadership requiring advanced subject matter knowledge.
High school diploma/GED or equivalent working knowledge.
A minimum of three to four years experience in Medical and/or Dental claims adjudication in an automated environment. Must have an excellent understanding of medical terminology, contract and benefit interpretation, CPT, HCPCS and ICD-9/ICD-10 coding with a working knowledge of Medicare, AHCCCS, Self-funded and/or commercial insurance plans.
Must possess strong oral and written communication skills including effective interpersonal skills and attention to detail and accuracy.
Preferred Qualifications
Previous claims auditing experience is preferred, Associates degree in related field.
Additional Related Education And/or Experience Preferred.
DATE APPROVED 10/29/2015
Estimated Pay Range:
$21.01 - $31.51 / hour Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.
EEO Statement:
EEO/Disabled/Veterans
Our organization supports a drug-free work environment.
Privacy Policy:
Privacy Policy
Salary : $21 - $32