Tucson is set in a Sonoran Desert valley surrounded by five mountain ranges. Boasting an average 350 sunny days a year and warm dry air, the climate is ideal for year-round outdoor recreation. Tucson offers one-of-a-kind experiences for those interested in outdoor adventure and nature, heritage and culture, arts and attractions, golf and original Southwest-inspired dining.
A rewarding career that fits your life. Banner Staffing Services offers a world of opportunities to make an impact on one of the country's leading health systems. If you're looking to leverage your abilities - you belong at Banner Staffing Services.
Banner Staffing Services (BSS) offers Registry/Per Diem opportunities within Banner Health. Registry/Per Diem positions are utilized as needed within our facilities. These positions offer flexibility in scheduling and are great way to start your career with Banner Health. As a BSS team member, you are eligible to apply (at any time) as an internal applicant to any regular opportunities within Banner Health.
As a valued and respected Banner Health team member, you will enjoy: Competitive wages Paid orientation Flexible Schedules (select positions) Fewer Shifts Cancelled Weekly pay 403(b) Pre-tax retirement Employee Assistance Program Employee wellness program Discount Entertainment tickets Restaurant/Shopping discounts Auto Purchase Plan
Registry/Per Diem positions do not have guaranteed hours and no medical benefits package is offered. Registry/Per Diem positions require a minimum of 4 shifts a month commitment. Completion of post-offer Occupational Health physical assessment, drug screen and background check (includes; employment, criminal and education) is required.
POSITION SUMMARY This position supervises the eligibility, payment distribution, claims processing and reimbursement functions for all self-insured, risk plans, capitated plans and third party administrator related activity. Through effective staffing and management of work functions, assures the accurate, timely and cost-effective completion of all payment and claims examination processes including data entry, adjudication, claims editing, auditing, and reporting.
CORE FUNCTIONS 1. Supervises the operations of all reimbursement services for third party, ERISA, commercial risk, capitation, and third party administrator contracts. Develops, manages and maintains work processes and procedures for the company's benefits plan eligibility, capitation payments, claims adjudication, processing and reimbursement services.
2. Selects, trains, coaches, motivates, conducts performance evaluations, and directs the workflow for the assigned Reimbursement Services staff. Develops goals and performance expectations for staff and manages staff performance.
3. Maintains all required records. Supervises and coordinates the maintenance of all aspects of internal records associated with the department's management information and claims payment system. Responsible for maintaining department reporting obligations to internal and external constituents.
4. Maintains a current and thorough knowledge of the Summary Plans Descriptions for each health plan serviced, and provides training, resources and information to the claims staff to enable the correct and timely adjudication of all provider and member claims.
5. Meets organization criterion related to claims turn-around, quality, and provider payment requirements. Accountable for ensuring high performance outcomes through an integrated process of operational, quality, medical cost and resource management.
6. Supervises human and material resources needed to maintain or exceed department standards. Participates in the development of the department budget in conjunction with established goals and objectives. Plays a key role in ensuring budgetary goals are met on an annual basis.
7. Manages monthly capitation payment determination and payment distribution for all providers with current capitation contracts.
8. Manages daily payment and check processing and distribution for all claims and capitation payments for the company's reimbursement services.
9. Works independently under limited supervision. Manages all aspects of the function for the company. Has freedom to determine how to best accomplish functions within established procedures.
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.
Must possess the knowledge typically gained from the completion of a Bachelor's degree in a business, finance or accounting field or the equivalent training and experience.
Requires the knowledge normally acquired over five or more years of experience in claims administration and management of reimbursement services. Must possess extensive knowledge of managed care, commercial insurance contracts, and governmental reimbursement methodologies and claims processing systems. Must have demonstrated success in effective decision making in managing a diverse staff.
Additional related education and/or experience preferred.
Internal Number: R24831
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.