Claims Auditor

Department Name:

Claims Processing

Work Shift:

Day

Job Category:

Finance

Estimated Pay Range:

$23.16 - $34.74 / hour, based on location, education, & experience.

In accordance with State Pay Transparency Rules.

The future is full of possibilities. At Banner Plans & Networks, we’re changing the industry to reduce healthcare costs while keeping members in optimal health. If you’re ready to change lives, we want to hear from you.

Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities.

As a Claims Auditor with Banner Plans & Networks, you will call upon your claims processing experience daily. You will audit claims and inform team members, educators, and leadership about findings and common areas that need continued education. Please note familiarity with the IDX Claims System and Medicare and Medicaid claims processing highly preferred.

Your work location will be entirely remote. Your work shifts will be Monday-Friday in the Arizona Time Zone business hours. If this role sounds like the one for you, Apply Today!

This is a fully remote position and available if you live in the following states only: AK, AL, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, MI, MN, MO, MS, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI & WY. This position is fully remote with travel less than 15% of the time to either a Banner corporate or hospital site.  With this remote work, candidates must be self-motivated, possess moderate to strong tech skills and be able to meet daily and weekly productivity metrics

Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

POSITION SUMMARY
This position will audit and monitor claims for accuracy, benefit payment, contract interpretation and compliance with policies and procedures.
CORE FUNCTIONS
1. Conducts random claims audits, high dollar claim audits, focus audits on a pre and post-payment basis and records audit findings. Calculates processor quality percentages as directed by leadership using audit results.
2. Conducts and documents specialized audits as needed and as requested by claims supervisors such as high dollar audits, out of network audits, new employee, employee quality improvement, or audits deemed by the cost containment claims committee.
3. Maintains working knowledge of Medicaid, Commercial, and Medicare rules and regulations as applicable to lines of business being audited as well as knowledge of CPT, ICD-9/ICD-10 coding, HCPCS and DRGs.
4. Utilizes resources such as payment guidelines, Medicaid, Commercial plans, CMS guidelines and other resources to validate audit parameters and results as well as provide leaders with references for education and performance management.
5. Assists leadership staff in developing and maintaining specific work procedures, policies and procedures and process improvement projects.
6. Assists claims leadership staff in developing and maintaining specific work procedures, policies and procedures and process improvement projects.
7. This position generally works within guidelines and policies, but participates and provides input on policy changes within a department or similar departments across the region or company. Incumbent performs essential functions with limited supervision.
MINIMUM QUALIFICATIONS
Two years of experience in a claims processing environment using various claims pricers and ability to understand provider contract; language and terms. Ability to successfully impart information in a group or individual setting. Strong written and verbal communication skills.
Strong working knowledge of Microsoft Office software (Word, Excel, Access). In-depth knowledge and experience with Medicaid, Commercial and Medicare health plans. Ability to work independently and pay attention to details.
PREFERRED QUALIFICATIONS

Two years of claims processing CMS1500 professional forms, UB facility forms, and dental forms preferred.
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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