Work in Arizona Jobs

Job Information

Banner Health Program Claims Manager in Mesa, Arizona

Primary City/State:

Mesa, Arizona

Department Name:

Claims Processing

Work Shift:

Day

Job Category:

General Operations and Culinary Services

Find your path in health care. Banner Health is committed to not only providing the finest care possible, but to advancing the way care is provided. To achieve our vision, we seek out professionals who embrace change and who possess the passion and skills to make it happen. Apply today.

As a Health Plan Program Manager you will need to have significant claims processing and system experience, IDX claims processing high level of proficiency. Must be excellent in researching AHCCCS and CMS guidelines. Our Department process all claims for Banner AHCCCS and Medicare Advantage products and continually look for ways to increase efficiency as measured by improving throughput and quality.

Must be collaborative with good presentation skills and have ability to identify and strategize using data. Hard working, focused on quality and quantity and team oriented. Banner is a growing company and this position will have growth potential. Are you detail oriented and a subject matter expert? Come join our team.

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.

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 assisting with ensuring ongoing compliance and operational performance of new and extant Medicaid, Medicare and Commercial programs and projects. Works both independently and collaboratively with all health plan functional areas with the purpose to support the development, implementation, maintenance, monitoring, and continuous improvement of the Medicaid, Medicare and Commercial lines of business. Must possess advanced organizational and matrixed management skills to manage the highly complex ongoing and periodic processes including but not limited to the dissemination and verification of the implementation of regulatory and sub-regulatory guidance and rule changes issued by the products’ regulatory authorities, filing various documents, forms and responses to each regulatory authority and management of many periodic processes including but not limited to Medicaid, Medicare and Commercial program bid submission, periodic Service Area Expansions, MA and HIX Call letter implementation, annual readiness review attestation, and Commercial product and rate development. This position may be responsible for supervising and directing Medicaid, Medicare and Commercial Programs that provides the clerical and technical support for the Health Plans.

CORE FUNCTIONS

  1. Ensures all Medicaid, Medicare, MA and Commercial (both on and off the exchange) regulatory, sub-regulatory and policy guidance are disseminated in a timely manner and that such guidance is strictly adhered to, implemented and monitored and that evidence of implementation is verified and documented.

  2. Manages the annual Medicaid, Medicare, and MA Bid process and periodic Commercial product and rate development. Manages the Service Area and Market Expansion process as necessary.

  3. Manages or oversees the submission of all required materials and forms (i.e. Formulary Submission, annual website updates, marketing materials, Low Income Subsidy (LIS) match rates, monthly encounter data and Part C and D reporting, Policies, Evidence of Coverage) and data to the regulatory body overseeing a particular line of business.

  4. Manages the development of the New Member Notifications. Assists Marketing with the production of all member materials for the Medicaid, Medicare and Commercial lines of business. Assists all functional areas with ensuring they are using the most current model member communications.

  5. Attends all relevant AHCCCS, CMS, ADOI and CCIIO user group calls and meetings.

  6. Assists with researching and tracking the Medicaid, Medicare and Commercial legislative environment and initiatives in collaboration with Legislative Affairs. Ensures the regulatory reporting requirements for the Medicaid, Medicare and Commercial lines of business are timely, accurate and compliant.

  7. Manages the production of the Monthly Operational Dashboard. Ensures functional areas are compiling and reporting the data that comprise the Monthly Medicare Compliance Dashboard.

  8. Collaborates with Network Development to ensure Medicaid, Medicare and Commercial Provider contracts meet regulatory requirements.

  9. Provides process/program management and coordination to Health Plan teams/workgroups. Includes partnering with project and clinical leaders across the organization. Requires interactions with all levels of staff, management and physicians.

MINIMUM QUALIFICATIONS

Must possess a knowledge as normally obtained through the completion of a Bachelor’s degree in health care administration, finance administration or project management or equivalent combination of work experience.

This position requires the skills, knowledge and abilities typically acquired over one year of related experience and education. The work requires a high degree of organization, the ability to manage time and resources effectively, and the self-starter ability to work independently to achieve goals. Effective customer service and interpersonal relations skills are necessary. The ability to communicate effectively verbally, in writing and through common computer software is required.

PREFERRED QUALIFICATIONS

Health Plan and Case Management experience and prior experience working in Medicaid and/or Medicare health plans preferred

Additional related education and/or experience preferred.

Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability.

DirectEmployers