Claims Processor

Department Name:

Banner Staffing Services-AZ

Work Shift:

Day

Job Category:

Finance

A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you’re looking to leverage your abilities – you belong at Banner Health. 

As a Claims Processor, your responsibilities will include processing new age claims (according to guidelines) and keeping them under 30 days along with aging reports and processing. Knowledge and understanding of contracts with providers, CPT/HCPCS, excel, CMS 1500 form and UB-92 form will be helpful in this role. You will submit service requests for claim updates or needs to complete the claim. You will participate in team activities and assist with processing 175-200 claims per day for CMS with 95% or better QA. Logging claims for claims escalations and helping helping others reach the team goals. Hours of operation are 6AM-5:30PM Monday - Friday, your schedule can be chosen hours once you complete training/ramp.

POSITION SUMMARY
This position, under general direction, will provide support to the claims department leadership team, trainer/auditors and systems team to ensure the department’s compliance goals are met.

CORE FUNCTIONS
1. Data-enters and adjudicates internal and external claims on a timely basis in accordance with departmental policies, procedures and standards.

2. Researches resubmitted or corrected claims and pend appropriately. Adheres to governmental guidelines for processing claims.

3. Refers fee schedule, vendor contract, plan problems or concerns to manager or senior level processors for intervention. Enters Siebel requests for provider updates, medical review, enrollment review, and coding review. Trouble shoots, identifies, and resolves special handling requirements related to pricing, contracting, and system issues. Processes CMS 1500 and/or UB04 claims.

4. This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at all levels throughout the organization.

MINIMUM QUALIFICATIONS

Knowledge, skills and abilities typically obtained through two years of medical billing or claims processing experience or proven ability to be successful in this position.

Knowledge of CPT-4, ICD-9, and HCPCS codes, and CMS 1500 and/or UB04 forms. Good interpersonal skills, strong decision making skills.

Knowledge of Health Plan policies and/or AHCCCS regulations and IDX system. Ability to meet minimum production standards, research and process complex claims.

PREFERRED QUALIFICATIONS

Two years of IDX claims system experience preferred.

Additional related education and/or experience preferred.

Estimated Pay Range:

$18.02 - $27.03 / hour Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.

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EEO/Disabled/Veterans

Our organization supports a drug-free work environment.

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