Processes corrections to claims accurately and in a timely manner. Assists with claim inquiries while maintaining production and quality standards in accordance with department processing standards of monitoring back outs greater than one year.
Performs detailed research and reprocessing of AHCCCS, Medicare (Special Needs Plan) and commercial claims using a back out function in IDX. The back out function takes the original claim and produces a replacement claim number. The claim is reprocessed on the replacement claims according to the nature of the request.
Reviews and reprocesses AHCCCS, Medicare, and Commercial Provider requests via Customer Care Calls.
Trouble shoots, identifies, and resolves special handling requirements related to pricing, contracting, and system issues.
Serves as liaison with between departments such as Network Development, Medical Management, Finance and IS to research and rework projects submitted.
Reviews and reports all types of claims that are reprocessed into the claims adjustment database. Information is used to identify trends and to implement front end processes that will reduce rework.
Coordinates and submits projects to the Claims Systems team that can be reprocessed by auto adjudicating the claims through an electronic process in IDX.
Researches and/or reprocesses special, high profile, expedited projects from Grievance and Appeals, finance and Network Development.
Knowledge, skills and abilities as normally obtained through two years of experience in medical billing. Knowledge of Health Plan policies, AHCCCS, Commercial and Medicare rules and regulations, IDX system. Knowledge of CPT-4, ICD-9, and HCPCS codes and knowledge of CMS 1500 and/or UB04 forms.
Requires good interpersonal skills and strong decision making and organizational skills. Excellent customer service skills, strong analytical, and written and verbal communication skills required. Ability to work and prioritize multiple tasks and to use Microsoft Word and Excel required. Working knowledge of all claim form types to include 1500 professional forms and UB facility forms.
Two years of experience processing claims with IDX platform.
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.