Clinical Information Review Analyst
Company: Drug Information Association Inc
Location: Scottsdale
Posted on: June 8, 2021
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Job Description:
Primary City/State: Scottsdale, Arizona Department Name: Banner Staffing Services-AZ Work Shift: Day Job Category: Revenue Cycle 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: 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 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 Evaluates and intervenes concurrently and retrospectively for
level of care, coverage issues, payor outliers, split billing,
disallowed charges, patient inquires, denial and compliance
issues. 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. Tracks, monitors and documents denial causes and resolutions
with appropriate management staff. Acts as a knowledge resource for billing staff members.
Identifies educational needs regarding payor issues, functions as
preceptor, and provides appropriate education. Builds and continually updates a knowledge of Third Party Payor
requirements for covered treatment protocols by diagnosis, approval
requirements for procedures, and coverage norms. 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. 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. 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 BUMG, BUMCT, or BUMCS in a Behavioral
Health clinical setting that serves children must possess an
Arizona Fingerprint Clearance Card at the time of hire and maintain
the card for the duration of their employment. 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.
Keywords: Drug Information Association Inc, Scottsdale , Clinical Information Review Analyst, Other , Scottsdale, Arizona
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