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Third Party Liability Representative will partner with external providers, legal entities and other internal Banner Health departments to attempt to recover payment of funds that have been paid by Banner Insurance Division.
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Banner University Health Plans (BUHP) manage a variety of health plans. Our mission is to advance health and wellness through education, research and patient care. About Banner Health Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.
POSITION SUMMARY The primary purpose of this position is to monitor submission and ensure collection of reimbursement for processed and paid claims that meet criteria for AHCCCS and other stop loss (AHCCCS reinsurance, AHCCCS catastrophic reinsurance, commercial stop loss) reimbursement and third party liability (TPL) claims. This position is also responsible for the monthly reporting of claim activity.
CORE FUNCTIONS 1. Produces, collects, and/or reviews reports or other information to identify paid claims that qualify as reimbursable cases for reinsurance, transplantation reimbursement, or TPL cases.
2. Maintains working knowledge and adheres to any reinsurance or transplantation reimbursement policy's benefits and submission requirements.
3. Maintains working knowledge and adheres to how to bill and collect for TPL claims. Adheres to government and industry guidelines in the preparation and collection of all cases.
4. Submits claims for all paid claim reimbursement (reinsurance), transplantation, or TPL cases in a timely and accurate manner.
5. Works with payers of all cases to reconcile any claims issues in a timely, accurate and professional manner. Provides the information and assistance necessary to the payers. Corresponds with outside payers. Follows up with the payer of all cases that are not collected in a timely manner. Ensures that collections are made when monies are due.
6. Works with payers of all cases to reconcile any claims issues in a timely, accurate and professional manner. Provides the information and assistance necessary to the payers. Corresponds with outside payers. Follows up with the payer of all cases that are not collected in a timely manner. Ensures that collections are made when monies are due.
7. Maintains accurate and complete individual files for all cases, which include documentation of all claims and follow-up activity for the case. Produces timely and accurate monthly reports that summarize the billing and collecting activity of all cases.
8. Reviews the AHCCCS Reinsurance System to identify pended claims and correct or coordinate the correction of the claims in a timely manner. Maintains paid claim reimbursement (reinsurance) desk top procedures manual and formal paid claims reimbursement (reinsurance) policies.
9. Works independently under limited supervision. Makes independent judgments based on specialized knowledge for accurate assignment of criteria/guidelines, and of billing and coding according to national guidelines. Confers with supervisor on any unusual situations. Internal customers: All levels of nursing management and staff, Medical Directors, and all other members of the interdisciplinary health care team, including Reimbursement Services, and HIMS. External customers: Physician and their office/clinic staff, delegated clients, patient/family.
MINIMUM QUALIFICATIONS 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 two or more years of experience in claims administration and management of reimbursement services. Must have demonstrated success in effective decision making in managing a diverse staff. Must possess knowledge of AHCCCS encounter regulations and guidelines. Ability to communicate effectively, both verbally and in writing. Requires an organized individual who can prioritize the workload to efficiently produce timely and accurate results under varying situations. Skills to manage significant amounts of electronic data through the use of a computerized office suite. Ability to communicate with AHCCCS technical and managerial personnel to identify system problems related to both procedures and programming.
PREFERRED QUALIFICATIONS Familiarity with coordination of benefits and third party liability issues and reinsurance is preferred.
Additional related education and/or experience preferred.
DATE APPROVED 06/7/2015
Internal Number: R16799
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.