Registered Nurse Clinical Information Specialist

Banner Health•Phoenix, AZ

1d•Remote

About The Position

Banner Health recently earned Great Place To Work® Certification™. This recognition reflects our investment in workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of our team members. Join Banner Health's Utilization Review Department (BHURD) as a fully remote RN, where your acute bedside expertise will directly impact patient care across our entire health system. With a minimum of 5 years of hands-on nursing experience, you'll conduct critical medical and surgical reviews for patients at all Banner facilities, applying evidence-based guidelines to ensure appropriate care status and collaborating with providers on clinical decisions. This isn't your typical remote role—you'll be part of a highly motivated, experienced team with an exceptional retention rate of less than 1%, working independently while meeting daily metrics that drive meaningful outcomes. Enjoy the flexibility of working from home while receiving comprehensive support through our robust 12-week one-on-one preceptorship program, complete with weekly check-ins and clear success milestones. If you're a seasoned acute care nurse ready to leverage your clinical judgment in a new way, contribute to system-wide quality initiatives, and join a stable, high-performing team that values expertise and accountability, this opportunity offers the perfect blend of autonomy, impact, and work-life balance. Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care. 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 support appropriate utilization of healthcare services. Provides clinical knowledge to assist billing and collection team members in responding to insurance denial of billings.

Requirements

Requires Registered Nurse (R.N.) licensure in the state of practice.
Requires five or more years of clinical nursing 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.

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.