Claims Processor

Banner Health•Mesa, AZ

4d•Onsite

About The Position

Banner Staffing Services (BSS) offers Registry/Per Diem opportunities within Banner Health. Registry/Per Diem positions are utilized as needed within our facilities. These positions are great way to start your career with Banner Health. As a BSS team member, you are eligible to apply (at any time) as an internal applicant to any regular opportunities within Banner Health. Learn more at https://youtu.be/Pu3VR3tGlw0 The Claims Processor are given a work que, their work que is allotted 200 claims daily. The processors are to complete these 200 claims by the end of their shift. We process claims in a first in first out basis. Our overall goal is to keep our claim inventory under 30 days out. Previous claims processing experience and provider billing highly preferred. Schedule: Monday through Friday 8-hour shift between 6am – 4:30pm Arizona Residency Required. As a valued and respected Banner Health team member, you will enjoy: Competitive wages Paid orientation Flexible Schedules (select positions) Fewer Shifts Cancelled Weekly pay 403(b) Pre-tax retirement Resources for living (Employee Assistance Program) MyWell-Being (Wellness program) Discount Entertainment tickets Restaurant/Shopping discounts Registry/Per Diem positions do not have guaranteed hours and no medical benefits package is offered. Completion of post-offer Occupational Health physical assessment, drug screen and background check (includes employment, criminal and education) is required. POSITION SUMMARY This position, under general direction, will provide support to the claims department leadership team, trainer/auditors and systems team to ensure the department’s compliance goals are met. CORE FUNCTIONS 1. Data-enters and adjudicates internal and external claims on a timely basis in accordance with departmental policies, procedures and standards. 2. Researches resubmitted or corrected claims and pend appropriately. Adheres to governmental guidelines for processing claims. 3. Refers fee schedule, vendor contract, plan problems or concerns to manager or senior level processors for intervention. Enters Siebel requests for provider updates, medical review, enrollment review, and coding review. Trouble shoots, identifies, and resolves special handling requirements related to pricing, contracting, and system issues. Processes CMS 1500 and/or UB04 claims. 4. This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at all levels throughout the organization.

Requirements

Knowledge, skills and abilities typically obtained through two years of medical billing or claims processing experience or proven ability to be successful in this position.
Knowledge of CPT-4, ICD-9, and HCPCS codes, and CMS 1500 and/or UB04 forms.
Good interpersonal skills, strong decision making skills.
Knowledge of Health Plan policies and/or AHCCCS regulations and IDX system.
Ability to meet minimum production standards, research and process complex claims.

Nice To Haves

Two years of IDX claims system experience preferred.
Additional related education and/or experience preferred.

Responsibilities

Data-enters and adjudicates internal and external claims on a timely basis in accordance with departmental policies, procedures and standards.
Researches resubmitted or corrected claims and pend appropriately. Adheres to governmental guidelines for processing claims.
Refers fee schedule, vendor contract, plan problems or concerns to manager or senior level processors for intervention.
Enters Siebel requests for provider updates, medical review, enrollment review, and coding review.
Trouble shoots, identifies, and resolves special handling requirements related to pricing, contracting, and system issues.
Processes CMS 1500 and/or UB04 claims.
This position works under supervision, prioritizing data from multiple sources to provide quality care and support.
Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service.
Interacts with staff at all levels throughout the organization.