Director, Claims Recovery Unit

$104,250 - $173,763/Yr

Banner Health - Phoenix, AZ

Full-time - Director

Phoenix, AZ

1,001-5,000 employees

Hospitals

About the position

The Director of the Claims Recovery Unit (CRU) at Banner Health is responsible for leading a team that monitors and manages claims payments for accuracy, identifies deficiencies in payments, and collaborates with vendors to correct discrepancies. This role involves overseeing the recovery of claim overpayments, managing external vendors, and ensuring compliance with regulatory standards. The position requires strong leadership skills and experience in medical billing and coding, as well as the ability to analyze data and present findings to senior leadership.

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 partners.
• Monitor and identify new recovery concepts to reduce claims overpayments within the claims system.
• Conduct in-depth analysis using dashboards and reports to evaluate the root cause of overpayments and implement solutions.
• Present results and proposals to senior leadership based on data analysis.
• Work with the network to resolve complex provider recovery issues and prevent costly overpayment recoveries.
• Collaborate with various departments to customize messages and ensure financial and operational commitments are met.

Requirements

• Bachelor's degree in health administration or equivalent working knowledge in healthcare.
• Certified professional coder (CPC or equivalent).
• 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 Microsoft Excel and PowerPoint experience.

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 preferred.
• Experience in a high volume production/analytical environment with financially based goals.

Benefits

• Health insurance
• Financial benefits
• Security benefits
• Management Incentive Program eligibility