Claims Audit Manager
FacilityBanner Health Network & Banner Plan Administration
DepartmentBanner Health Network & Banner Plan Administration - Claims Processing
Street Address 1441 N. 12th St.
City & StateUS-AZ-Phoenix
Position TypeFT: Full-Time
Posting CategoryLeadership - Non-Clinical
Good health care is key to a good life. At Banner Health, we understand that, and thats why we work hard every day to make a difference in peoples lives. Weve united under a common goal: Make health care easier, so life can be better. Its a lofty goal, but its one were committed to seeing through. Do you like the idea of making a positive change in peoples lives - and your own? If so, this could be the perfect opportunity for you. Apply now.
BPA Reimbursement Services is responsible for claims processing, adjustments, refunds, reconsiderations, projects, incoming checks and cash, eligibility and claims funding for BHN. There is also a responsibility for the oversight of the BCBS Advantage reimbursement, adjustments and refund processes.
As a Claims Auditor Manager you will manage the daily auditing functions for all Banner product lines to include Medicare, Medicaid, Commercial, self-insured, risk plan, and third party administrator related activity. You will be responsible for day-to-day department functions, including staff placement, training, supervision and productivity for all auditing processes, including focus audits, plan audits data entry and reporting.
Monitor ing claims data looking for possible fraudulent billing from providers, support claim system coding, provider contract language and assist with general provider billing question.
Mesa Corp. Office
525 West Brown Rd.
Mesa, AZ 85201
Mon-Fri 8am 5pm
Impact claims system (prefered)
About Banner Health Network & Banner Plan Administration
Banner Health Network (BHN) is an accountable care organization that joins Arizonas largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
About Banner Health
Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.
This position supervises the daily auditing functions for all Banner product lines to include Medicare, Medicaid, Commercial, self-insured, risk plan, and third party administrator related activity. Responsible for day-to-day department functions, including staff placement, training, supervision and productivity for all auditing processes, including focus audits, plan audits data entry and reporting.
Supervises human and material resources and work activities in the day-to-day operations of assigned area for all auditing functions and all lines of business to ensure staff are maintaining performance at a level that meets or exceeds department standards.
Hires, trains, and supervises the department staff. Provides leadership, coaching, recognition, and conducts corrective action and performance evaluations. Establishes priorities, workloads, schedules, controls and work procedures
Supervises and coordinates proper maintenance of all on internal records associated with the departments management information and claims payment system.
Provides resources and information to the claims staff that will allow for correct and timely adjudication of all provider and member claims. Maintains a thorough and current knowledge of the Summary Plans Descriptions for each health plan serviced.
Monitors and reports on work performance against established criteria related to claims accuracy and provider payment requirements.
Knowledge as normally obtained through the completion of a bachelors degree or equivalent work experience.
Requires 3 or more years of experience in reimbursement, claims and related systems, provider contract interpretation, system development and previous experience with leadership position demonstrating effective communication with employees, providers, vendors and customers. Must have a strong knowledge and understanding of managed care, commercial insurance, Medicaid, and CMS reimbursement methodologies. Must demonstrate a track record of effective and mature decision making in managing a diverse staff.
Additional related education and/or experience preferred.Previous lead or supervisory experience
Additional related education and/or experience preferred.
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