Clinical Information Review Analyst Behavioral Health

Banner Health • Glendale, AZ

2d • Onsite

About The Position

This position reviews clinical information and conducts audits of billings to determine appropriateness of charges in accordance with contracted payor terms, standards of care and insurance policy parameters. Works with physicians, patients, payors and other healthcare providers to support appropriate utilization of healthcare services. Provides clinical knowledge to assist billing and collection team members in responding to insurance denial of billings. Banner Health has made a significant investment in behavioral health services both in capital improvement, new construction, and clinical training opportunities in the past few years. Our medical facilities appreciate our proactive ability to move the behavioral health patients out of the emergency departments and into the behavioral health setting. We pride ourselves on the diversity of our staff and the wide range of clinical expertise our case managers bring to their roles on the units. Banner Health’s premier West Valley Level I Trauma for adults and Tertiary Care destination for all ages. Banner Thunderbird Medical Center (BTMC) and Banner Children’s Hospital at Thunderbird provide a preferred destination for surgical, oncological, cardiovascular, neuroscience, orthopedic, pediatric, and women and infant services achieved through best-in-class 5-star CMS rating to provide patients with high quality, safe care for the best possible experience. Our campus is one of the largest campuses in the Banner network with over 3000 employees. BTMC was voted Best of the Best in 2023 by Banner Health out of 30 hospitals. This is the most prestigious award one of our largest hospitals can receive for consistently meeting our annual targets. If you would like to contribute to truly leading edge caring, we invite you to bring your experience and skills to Banner Thunderbird.

Requirements

• Requires Registered Nurse (R.N.) licensure in the state of practice.
• In a Behavioral Health setting requires Registered Nurse (R.N.) licensure in the state of practice or a current Arizona Board of Behavioral Health Examiners License based on an accredited Master's degree.
• Requires five or more years of clinical nursing or related experience or, in a Behavioral Health setting, Master's level Social Work in healthcare, behavioral health counseling, or related experience.
• Experience in evaluation techniques, teaching, hospital operations, reimbursement methods, medical staff relations, and the charging/billing process is required.
• A working knowledge of utilization management and patient services is required.
• A working knowledge of Medical and third party payor requirements and reimbursement methodologies is required.
• Highly developed human relation and communication skills are required.
• Excellent organizational, written and verbal communication skills are essential for this position.
• Employees working at Banner Behavioral Health Hospital, BTMC Behavioral, and BUMG, BUMCT, or BUMCS in a Behavioral Health clinical setting that serves children must possess an Arizona Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment.
• An Arizona Criminal History Affidavit must be signed upon hire.
• Employees working in the Banner McKee Senior Behavioral Health Inpatient Unit must possess a Colorado Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment.
• Employees working in any Banner Staffing (BSS) Behavioral Health role in Arizona must possess a State of Arizona Department of Public Safety Level One Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment.

Nice To Haves

• A Bachelor of Science degree in Nursing is preferred.
• Additional related education and/or experience preferred.

Responsibilities

• Evaluates and intervenes concurrently and retrospectively for level of care, coverage issues, payor outliers, split billing, disallowed charges, patient inquires, denial and compliance issues.
• Initiates actions and participates with Patient Financial Services payor teams regarding resolution of denial management issues or compliance issues. Works with authorized payors or reviewers to resolve denial management issues, reconsiderations and appeals.
• Tracks, monitors and documents denial causes and resolutions with appropriate management staff.
• Acts as a knowledge resource for billing staff members. Identifies educational needs regarding payor issues, functions as preceptor, and provides appropriate education.
• Builds and continually updates a knowledge of Third Party Payor requirements for covered treatment protocols by diagnosis, approval requirements for procedures, and coverage norms.
• Provides education by collaborating with Care Coordination at company facilities or other staff of non-company locations on concurrent and retrospective utilization review. Accurately and thoroughly completes documentation required for claims payment of services approved through concurrent review and case management.
• Works independently under limited supervision. Makes independent judgments based on specialized knowledge. Holds Facility or Regional responsibility for audited and denied billing issues.

Benefits

• We provide health and financial security options so you can focus on being the best at what you do and enjoying your life
• comprehensive benefit package for all benefit-eligible positions

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree