This position responds to and resolves advanced to complex level issues related to the daily administration and operation of potential and existing providers and may involve provider education, interpreting and developing policies, procedures and guidelines. Provides in-service to appropriate personnel in regard to changes and updates in system support files.
Travels frequently to physicians offices doing site visits, educating office staff, recruiting new offices, and resolving established problems.
Provides education to physicians and their office staff. This includes, but is not limited to coordinating orientation and education of providers, hospitals and the organizations insurance plan administration staff.
Identifies and resolves managed care issues concerning claims, contract interpretation, utilization management, eligibility and general operational issues.
Maintains all levels of communication with network providers, informing them of any operational, procedural, and contractual changes and updates.
Assists internal departments in resolving provider and member appeals pertaining to the organizations physician, hospital, and insurance plan contracts.
Assists manager with network development in various geographic regions within the organization, negotiates, implements and maintains managed care contracts with payers and providers.
Must possess a strong knowledge of healthcare as normally obtained through the completion of a bachelors degree in business, healthcare administration, or related field.
Must have an excellent understanding of medical terminology and knowledge of CPT-4 and ICD-9 coding.
Must know how or learn to program data retrieval utilities and queries. The incumbent must possess the ability to track and analyze statistical data. This position requires a mathematical aptitude, computer experience, typing skills and the ability to work on a variety of projects in an organized fashion.Must have the ability to effectively communicate both verbally and in writing.
Three years of experience in the healthcare field preferred. Two years of medical claims auditing experience is preferable.
Additional related education and/or experience preferred.
Internal Number: 260344
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.