This position assists with the overall quality, monitoring, analysis, reporting and audit management as necessary by contractual and regulatory requirements for Banner payors. This position also identifies and refers system issues to Production Control and Reimbursement Services to prevent disruption in workflow of the entire PFS department. Facilitates credit balances and underpayments on patient accounts. Collects, verifies, analyzes and summarizes data; identifies trends and communicates results to management. Serves as a resource to provide leadership with the data, trends, analyses, and information needed to help minimize loss of revenue. Assists with compliance reporting to insurance carriers and other third parties as required.
Analyze patient accounts to ensure consistent reimbursement for services rendered with contracts. As needed, provide recommendation to managed care for payor contract changes including phrasing, process, and missing documentation.
As assigned, make corrections to inaccurate accounts by processing patient and insurance refunds, transfers, adjustments, credit card refunds and overpayment letters from insurance carriers in an accurate and timely manner. Coordinates with other staff members, hospital and physician office staff as necessary to ensure accurate processing.
Identify system processing issues and provide correction recommendations to Production Control. Once corrected, assist with complex testing to ensure system is working correctly, thereby preventing costly workflow disruption to PFS department .
Uses multiple systems and/or programs to provide statistical data and prepare issues list(s) to accurately communicate with payers. May attend Payer meetings as scheduled.
Build strong working relationships with other departments, hospital departments and external customers. Identifies and analyzes trends in overpayment/underpayment issues, reimbursements, and production control and communicates with internal and external customers as appropriate to educate and correct issues. Prepare and present reports to various groups including auditors, various levels of management, payers and vendors.
As assigned, reconcile and balance payments, work with insurance remits, facility contracts, provider representatives, and spreadsheets to ensure maximum reimbursement.
As assigned, respond to incoming calls and make outbound calls as required to resolve credit balance issues. Provide assistance and excellent customer service to patients, patient families, providers, and other internal and external customers.
May provide training to new staff, provide feedback to improve processes and works on special projects as required. May function as lead within unit.
Bachelors degree and minimum two years experience or an equivalent combination of education and experience. Strong mathematical skills required.
3-5 years related work experience in patient financial services work, and/or accounting and financial is required. Helpful to have an understanding of medical terminology, and a broad understanding of medical insurance laws and guidelines, insurance policy and coverage types, hospital billing procedures and payment policies, Medicare and AHCCCS laws and regulations on billing. Broad understanding of common terms and clauses of insurance contract language, math aptitude and flexibility to handle unanticipated work and able to manage multiple concurrent tasks. Must be able to evaluate insurance remits for accuracy in accordance with payor guidelines.
Requires strong organizational abilities, proficiency in Professional Customer Service, oral and written communications, accurate and efficient keyboarding with strong competencies in the use of common office software applications, the ability to create spreadsheets to analyze and present data. Requires effective teamwork skills and the ability to meet deadlines and productivity standards.
Work experience with the Companys billing/collections systems and processes or finance is preferred. Previous successful experience in a leadership role, previous experience in training and/or previous clinical experience is a plus.
Additional related education and/or experience preferred.
Internal Number: 248525
About Banner Health
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.