Director, Claims Recovery Unit

$104,250 - $173,763/Yr

Banner Health - Tucson, AZ

Full-time - Director

Tucson, AZ

1,001-5,000 employees

Hospitals

About the position

The Director of the Claims Recovery Unit (CRU) at Banner Health is responsible for overseeing the development, discovery, and recovery of claim overpayments. This role involves managing a small team and collaborating with external vendors to ensure accurate claims payments, identify billing errors, and implement effective recovery processes. The position requires strong leadership skills and experience in medical billing and coding, with a focus on reducing healthcare costs while maintaining compliance and operational efficiency.

Responsibilities

• Manage professional staff through ongoing training and development, fostering a collaborative team culture.
• Oversee CRU vendor performance and recovery activities related to data mining and claims recovery processes.
• Develop and maintain departmental plans and policies to ensure compliance with regulatory standards.
• Monitor and identify new recovery concepts to reduce claims overpayments and improve claims processing.
• Conduct in-depth analysis using dashboards and reports to evaluate the root causes of overpayments and implement solutions.
• Present results and proposals to senior leadership based on data analysis and recovery objectives.
• Work with network providers to resolve complex recovery issues and prevent costly overpayments.
• Collaborate with various internal departments to ensure financial and operational commitments are met.

Requirements

• Bachelor's degree in health administration or a related field.
• Certified Professional Coder (CPC) or equivalent certification.
• Seven years of medical billing and/or coding experience.
• Three years of experience with 1500 and UB claims auditing and analysis.
• Knowledge of Medicare/Medicaid reimbursement guidelines including MS-DRG and/or APR-DRG.
• Prior supervisory or management experience in a managed care environment.
• Excellent communication, presentation, and written skills.
• Basic proficiency in Microsoft Excel and PowerPoint.

Nice-to-haves

• Current unrestricted RN licensure in Arizona or equivalent nursing knowledge.
• Three years of experience in an acute patient care environment.
• Master's degree in a related field.
• Experience in a high-volume production/analytical environment with financial goals.

Benefits

• Health insurance coverage
• Financial benefits including participation in a Management Incentive Program
• Flexible work options including remote and hybrid settings
• Opportunities for professional development and training