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Banner Health Claims Examiner in Phoenix, Arizona

Primary City/State:

Phoenix, Arizona

Department Name:

Claims Processing

Work Shift:

Day

Job Category:

Finance

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.

The Reimbursement Services Team is a highly productive processing team with focus on quality in the claims we process. We take pride in pulling together as a team to get things done.

An ideal candidate would be a self starter and self motivated. Our department works as a team for a common goal where all members contribute. We are highly productive; with a relaxed atmosphere. Endless opportunities to promote and advance on this team.

Your pay and benefits are important components of your journey at Banner Health. Banner Health offers a variety of benefits to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.

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 adjudicates medical and dental insurance claims in a timely and accurate manner for the full range of company insurance products. The work includes responsibilities such as claim processing, audit of processed claims, claim adjustments, recovery of funds, process events and customer service relating to claims.

CORE FUNCTIONS

  1. Ensures adjudication of assigned medical claims in an accurate and timely manner to include the completion of adjustments, recovery of funds, member service incident reports, and the coordination of benefits.

  2. Verifies adjudicate claim payments independently and in accordance with plan guidelines. Claim payments must be directed and approved by the Claims Manager prior to adjudication.

  3. Provides timely and accurate information to plan members and providers regarding claims, benefits, member out-of-pocket expenses, and payments via telephone or in writing.

  4. Works independently under general supervision using structured work procedures. Makes judgments within a defined framework.

MINIMUM QUALIFICATIONS

High school diploma/GED or equivalent working knowledge.

The knowledge of medical claims typically acquired over two to three years of work experience in medical claims adjudication. Must also have thorough understanding and knowledge of the UB92 and HCFA 1500 forms, medical procedure terminology, contract interpretation and knowledge of CPT, HCPCS and ICD-9 coding and how they apply to claims adjudication. Must possess a working knowledge of Medicare, Medicaid, and self-funded insurance, coding rules and coverage guidelines based on the Medicare and HCFA rules and regulations. A complete understanding of the coordination of benefits functions to ensure proper payments or recovery of funds is required.

Requires the ability to work effectively with common office software, and to use effective oral and written communication, team working customer service skills.

PREFERRED QUALIFICATIONS

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.

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