| Primary City/State: Scottsdale, Arizona Department Name: Case Mgmt-Psych Work Shift: Day Job Category: Revenue Cycle The future is full of possibilities. At Banner Health, we're excited about what the future holds for health care. That's why we're changing the industry to make the experience the best it can be. If you're ready to change lives, we want to hear from you. This is a 32 hour work week- Monday, Tuesday, Thursday and Fridays- Business Hours. Banner Health has made a significant investment in behavioral health services both in capital improvement, new construction, and clinical training opportunities in the past few years. Our medical facilities appreciate our proactive ability to move the behavioral health patients out of the emergency departments and into the behavioral health setting. We pride ourselves on the diversity of our staff and the wide range of clinical expertise our case managers bring to their roles on the units. If you enjoy a fast paced and clinically stimulating environment and are looking to employ more of your clinical training, this is a fast-paced position assessing level of care for our patients. 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. For more than four decades, Banner Behavioral Health has provided nationally recognized, comprehensive behavioral health care for patients of all ages faced with the challenges of psychiatric, behavioral health, or chemical dependency problems. Six locations in and around Phoenix (including Chandler, Gilbert, Glendale, Phoenix, Scottsdale and Sun City West) make it easy for our patients to find help, and easy for you to have the neighborhood and lifestyle you want. Banner Behavioral Health is dedicated to providing safe, confidential and compassionate treatment. POSITION SUMMARY
This position reviews clinical information and conducts audits of billings to determine appropriateness of charges in accordance with contracted payor terms, standards of care and insurance policy parameters. Works with physicians, patients, payors and other healthcare providers support appropriate utilization of healthcare services. Provides clinical knowledge to assist billing and collection team members in responding to insurance denial of billings.
CORE FUNCTIONS
1. Evaluates and intervenes concurrently and retrospectively for level of care, coverage issues, payor outliers, split billing, disallowed charges, patient inquires, denial and compliance issues.
2. Initiates actions and participates with Patient Financial Services payor teams regarding resolution of denial management issues or compliance issues. Works with authorized payors or reviewers to resolve denial management issues, reconsiderations and appeals.
3. Tracks, monitors and documents denial causes and resolutions with appropriate management staff.
4. Acts as a knowledge resource for billing staff members. Identifies educational needs regarding payor issues, functions as preceptor, and provides appropriate education.
5. Builds and continually updates a knowledge of Third Party Payor requirements for covered treatment protocols by diagnosis, approval requirements for procedures, and coverage norms.
6. Provides education by collaborating with Care Coordination at company facilities or other staff of non-company locations on concurrent and retrospective utilization review. Accurately and thoroughly completes documentation required for claims payment of services approved through concurrent review and case management.
7. Works independently under limited supervision. Makes independent judgments based on specialized knowledge. Holds Facility or Regional responsibility for audited and denied billing issues. Internal customers: Patient/family, medical staff, case managers, nursing, social workers, patient services/placement/finances/audit, emergency department, clinic and all other departments and ancillary/support services. External customers: Medical Directors/payors/reviewers, contracted review agencies, other facilities/services, physician's offices.
MINIMUM QUALIFICATIONS
Requires Registered Nurse (R.N.) licensure in the state of practice. In a Behavioral Health setting requires Registered Nurse (R.N.) licensure in the state of practice or a current Arizona Board of Behavioral Health Examiners License based on an accredited Master's degree.
Requires five or more years of clinical nursing or related experience or, in a Behavioral Health setting, Master's level Social Work in healthcare, behavioral health counseling, or related experience. Experience in evaluation techniques, teaching, hospital operations, reimbursement methods, medical staff relations, and the charging/billing process is required. A working knowledge of utilization management and patient services is required. A working knowledge of Medical and third party payor requirements and reimbursement methodologies is required. Employees working at Banner Behavioral Health Hospital or BTMC Behavioral must possess an Arizona Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment.
Highly developed human relation and communication skills are required. Excellent organizational, written and verbal communication skills are essential for this position.
PREFERRED QUALIFICATIONS
A Bachelor of Science degree in Nursing is preferred.
Additional related education and/or experience preferred. |
