PFS Quality Analyst / Reconciliation and Credit Department / Mesa, AZ

Job Number
203892
Banner Health (Corporate)
Shift
Day
Department
Banner Health (Corporate) - PFS Recon Dept-Corp/SS
Position Type
FT: Full-Time
Street Address
2901 N. Central Ave
City & State
US-AZ-Phoenix
Posting Category
Billing / Registration / Scheduling
New Grad
No

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This position is located in Mesa, AZ

 

PFS Quality Analyst / Reconciliation and Credit Department  / Mesa, AZ

 

BANNER CORPORATE CENTER – MESA
525 WEST BROWN ROAD
MESA, AZ 85201

 

Banner Corporate Center Mesa is located on the SW corner of Country Club Dr. and Brown Rd in Mesa.

 

Patient Financial Services Reconciliation Department:

Recon department conducts accounting reconciliation of patient accounts in accordance with payer terms, regulatory guidelines, while meeting company standards of quality and productivity. Reconciliation department maintains a current knowledge of insurance, contracted provider, Medicare and state Medicaid terms and a current knowledge of related company accounting procedures and policies.

 

Desired Qualification are:

  • Ten key experience and personal computer and typing skills are required.
  • Excellent organization, customer services and critical thinking skills.
  • Requires basic knowledge of insurance contract language.
  • Should have the ability to evaluate payer remits for accuracy according to payer guidelines.
  • Must be able to work independently with minimal supervision
  • Should demonstrate proficiency in reviewing accounts, EOB’s and identifying specific payer requirements.
  • Should be familiar with computer applications, spreadsheets, database, and be able to learn, apply and adhere to legal documentation

 

Patient Financial Services Credit Balance Unit Department:

The Credit Balance Unit is responsible for timely and accurately processing refunds for Insurance/Patient over payments. All Insurance Payers are our responsibility working Medicare, Medicare HMO, Blue Cross, Tricare, AHCCCS and Contracted HMO payers. We work as a Team to meet Unit goals and provide  Excellent Customer Service.

 

Desired qualifications are: 

  • Strong Analytical skills
  • Critical Thinking skills (able to think outside the box)
  • Ability to reconcile accounts to identify cause of over payments
  • Strong computer skills in order to work independently on various computer systems
  • Able to work independently once trained
  • Strong Organizational skills
  • General knowledge of Medical Terminology, CPT/Hcpcs and ICD codes
  • Excellent Customer Service skills to assist Patients and Insurances
  • Knowledge of Insurance billing or work experience in Hospital or Physician office is preferred but not mandatory.

 

 

 

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About Banner Health Corporate
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.

 

Truven-2013
Stage7-2013

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 change the way care is provided. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

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Job Summary

This position assists with the overall quality, monitoring, analysis, reporting and audit management as necessary by contractual and regulatory requirements for Banner payors. This position also identifies and refers system issues to Production Control and Reimbursement Services to prevent disruption in workflow of the entire PFS department. Facilitates credit balances and underpayments on patient accounts. Collects, verifies, analyzes and summarizes data; identifies trends and communicates results to management. Serves as a resource to provide leadership with the data, trends, analyses, and information needed to help minimize loss of revenue. Assists with compliance reporting to insurance carriers and other third parties as required.

 

Essential Functions

  • Analyze patient accounts to ensure consistent reimbursement for services rendered with contracts. As needed, provide recommendation to managed care for payor contract changes including phrasing, process, and missing documentation.

 

  • As assigned, make corrections to inaccurate accounts by processing patient and insurance refunds, transfers, adjustments, credit card refunds and overpayment letters from insurance carriers in an accurate and timely manner. Coordinates with other staff members, hospital and physician office staff as necessary to ensure accurate processing.

 

  • Identify system processing issues and provide correction recommendations to Production Control. Once corrected, assist with complex testing to ensure system is working correctly, thereby preventing costly workflow disruption to PFS department .

 

  • Uses multiple systems and/or programs to provide statistical data and prepare issues list(s) to accurately communicate with payers. May attend Payer meetings as scheduled.

 

  • Build strong working relationships with other departments, hospital departments and external customers. Identifies and analyzes trends in overpayment/underpayment issues, reimbursements, and production control and communicates with internal and external customers as appropriate to educate and correct issues. Prepare and present reports to various groups including auditors, various levels of management, payers and vendors.

 

  • As assigned, reconcile and balance payments, work with insurance remits, facility contracts, provider representatives, and spreadsheets to ensure maximum reimbursement.

 

  • As assigned, respond to incoming calls and make outbound calls as required to resolve credit balance issues. Provide assistance and excellent customer service to patients, patient families, providers, and other internal and external customers.

 

  • May provide training to new staff, provide feedback to improve processes and works on special projects as required. May function as lead within unit.

 

 

Minimum Qualifications

Bachelors degree and minimum two years experience or an equivalent combination of education and experience. Strong mathematical skills required.

3-5 years related work experience in patient financial services work, and/or accounting and financial is required. Helpful to have an understanding of medical terminology, and a broad understanding of medical insurance laws and guidelines, insurance policy and coverage types, hospital billing procedures and payment policies, Medicare and AHCCCS laws and regulations on billing. Broad understanding of common terms and clauses of insurance contract language, math aptitude and flexibility to handle unanticipated work and able to manage multiple concurrent tasks. Must be able to evaluate insurance remits for accuracy in accordance with payor guidelines.

Requires strong organizational abilities, proficiency in Professional Customer Service, oral and written communications, accurate and efficient keyboarding with strong competencies in the use of common office software applications, the ability to create spreadsheets to analyze and present data. Requires effective teamwork skills and the ability to meet deadlines and productivity standards.

Preferred Qualifications

Work experience with the Companys billing/collections systems and processes or finance is preferred. Previous successful experience in a leadership role, previous experience in training and/or previous clinical experience is a plus.

Additional related education and/or experience preferred.