• Claims Processor

    Job Number
    220164
    Facility
    University Physicians Health Plans
    Department
    University Physicians Health Plans - HP Statewide Claims
    Street Address
    2701 E. Elvira Rd.
    City & State
    US-AZ-Tucson
    Shift
    Day
    Position Type
    FT: Full-Time
    Posting Category
    Administrative / Clerical
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    Good health care is key to a good life. At Banner Health, we understand that, and that’s why we work hard every day to make a difference in people’s lives. We’ve united under a common goal: Make health care easier, so life can be better. It’s a lofty goal, but it’s one we’re committed to seeing through. Do you like the idea of making a positive change in people’s lives – and your own? If so, this could be the perfect opportunity for you. Apply now.

     

    The Claims Department processes claims from all providers, contracted and non-contracted, as well as provides data to other departments, the state and federal entities and regulators, and Banner, as needed. Claim Adjuster, reviews resubmissions of AHCCCS, Medicare and ALTCS claims after detailed research.  Reviews Claims data that drives many other processes due to the services provided for system enhancements/corrections. Additionally, technology platform support and adjudication system testing and enhancements and processes are supported and managed from within the claims department with assistance from other departments.

     

    Schedule:

    Monday-Friday; flexibility with start time

    Full time, Day shift

     

    Location:

    2701 E Elvira

    Tucson, AZ 85756

     

    Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.

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    About University Physicians Health Plans
    The University of Arizona Health Plans (UAHP) manage a variety of health plans. Our mission is to advance health and wellness through education, research and 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 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.

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    Job Summary

    Under general direction this position will provide support to the claims department leadership team, trainer/auditors and systems team to ensure the departments compliance goals are met.

     

    Essential Functions

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

     

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

     

    • 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.

     

     

    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.

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