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This roles is remote for Arizona residents, it is Monday - Friday , 8 hour days with flexible shift opportunities. Ideal candidate will have knowledge of CPT-4, ICD-9, and HCPCS codes, and CMS 1500 and/or UB04 forms. Good interpersonal skills, strong decision making skills.

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.

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

NOTE: The core functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager.

SUPERVISORY RESPONSIBILITIES
DIRECTLY REPORTING
None
MATRIX OR INDIRECT REPORTING
None
TYPE OF SUPERVISORY RESPONSIBILITIES
N/A

Banner Health Leadership will strive to uphold the mission, values, and purpose of the organization. They will serve as role models for staff and act in a people-centered, service excellence-focused, and results-oriented manner.

PHYSICAL DEMANDS/ENVIRONMENT FACTORS
OE - Typical Office Environment: (Accountant, Administrative Assistant, Consultant, Program Manager)
Requires extensive sitting with periodic standing and walking.
May be required to lift up to 20 pounds.
Requires significant use of personal computer, phone and general office equipment.
Needs adequate visual acuity, ability to grasp and handle objects.
Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone.
May require off-site travel

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.

DATE APPROVED 06/07/2015

EOE/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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