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Recon responsibilities include ensuring the highest reimbursement possible per contract, state and federal guidelines. Posting contractual adjustments and trending issues for PFS.
This Patient Financial Services Quality Analyst will be responsible for reconciling insurance payments, trending issues, identifying over payments and underpayments and applying adjustments as needed, while following contract state and federal guidelines. Strong technical skills are a plus and will assist in being able to navigate through the system used. 10-key is also extremely helpful as there will be strong data entry. This is a very independent production-based role. role.
Your pay and benefits are important components of your journey at Banner Health. Banner Health offers a variety of benefits 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.
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.
POSITION 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.
CORE FUNCTIONS 1. 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.
2. 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.
3. 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 .
4. 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.
5. 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.
6. As assigned, reconcile and balance payments, work with insurance remits, facility contracts, provider representatives, and spreadsheets to ensure maximum reimbursement.
7. 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.
8. May provide training to new staff, provide feedback to improve processes and works on special projects as required. May function as lead within unit.
9. Works independently and self-directed under minimal supervision, following defined standards and procedures. Reports to a Supervisor or Manager. Uses critical thinking skills to solve problems and reconcile accounts in a timely manner. External customers include all hospital patients, patient families and all third party payers. Internal customers include facility medical records and patient financial services staff, attorneys, and central services staff members.
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.
Bachelor's degree and minimum two years' experience or an equivalent combination of education and experience. Strong mathematical skills required.
Three to five 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.
Work experience with the Company's 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.
Internal Number: R12876
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.