Nurse Reviewer
Banner Health (Corporate) - Phoenix, AZ

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About Banner Health Corporate

Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. With locations in Phoenix, Mesa and Sun City, Ariz. and Greeley, Colo., 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.

About Banner Health

Banner Health was selected as one of the Top Leadership Teams in Healthcare by Health Leaders Media, is one of the Top 100 Integrated Healthcare Networks in the nation according to SDI, and voted as one of the “ Best Places to Work ” in the Phoenix metro area by the Phoenix Business Journal. We encouraged you to read more information about Banner Health. We recommend the following options:
  • Why Banner Health?
  • Banner Health Benefits
  • Banner Health Careers

Job 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.

Essential 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.

Minimum Qualifications

Requires Registered Nurse (R.N.) licensure in the state of practice.

Requires five or more years of clinical nursing and/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.

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.

Banner Health - 2 years ago - save job
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If you thrive on change and you’re looking to be part of the future of health care, you belong at Banner Health. Our award-winning,...