Patient Financial Quality Analyst

Primary City/State:

Arizona, Arizona

Department Name:

Acute Billing & Follow Up-Corp

Work Shift:

Day

Job Category:

Revenue Cycle

A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you’re looking to leverage your abilities – you belong at Banner Health. 

This position assists with the overall quality, monitoring, analysis, reporting and audit management as necessary by contractual and regulatory requirements for Banner payors

Systems frequently used: Outlook, One Note, Excel, MS4, Fin Thrive, Cerner, OnBase

Schedule: Monday - Friday 8 hour days - AZ time zone

This can be a remote position if you live in the following states only: AK, AZ, AR, CA, CO, GA, FL, IA, ID, IN, KS, KY, LA, MD, MI, MO, MN, MS, NH, NM, NY, NC, ND, NE, NV, OH, OK, OR, PA, SC, TN, TX, UT, VA, WI, WV, WA, & WY 

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.

MINIMUM QUALIFICATIONS

Bachelor’s degree 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 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 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.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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