| Primary City/State: Tucson, Arizona Department Name: IPA Mgmt Work Shift: Day Job Category: Risk, Quality and Safety Health care is changing, and it's our goal to create a new model to answer America's health care challenges today and in the future. Our passionate and talented teams will be the change on the health care landscape in our communities - big and small. If taking access and delivery from complex to easy, from costly to affordable and from unpredictable to reliable sounds interesting to you, we want to hear from you. The Encounters Analyst will be responsible for facilitating the successful transmission and acceptance of all encounter data by AHCCCS and CMS. This will include pended encounter research and correction, to include the identification of claims processing problems that my impact the encountering of clean and accurate data to the State. This position will work alongside the claims department and HPIS encounters file generation team. An ideal candidate will be working remote from the Tucson or Phoenix area. Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life. 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, under the general direction of the Finance Sr Manager, will be responsible for facilitating the successful transmission and acceptance of all encounter data by AHCCCS. This may include pended encounter research and correction, file creation and audit prior to submission to AHCCCS, and the identification of claims processing problems that my impact the encountering of clean and accurate data to the State.
CORE FUNCTIONS
1. Creates monthly cycle encounter files and submits to AHCCCS via file transfer protocols. Reviews, researches and corrects encounter editing reports. Investigates pends to determine if correction is the responsibility of the plan or if they are due to AHCCCS system conditions.
2. Maintains encounter files along with all documentation that supports the processing cycle. Assists in drafting and updating or encounter policies and procedures as needed. Tracks the encounter pends and evaluates any training/system needs and communicates suggestions for process improvements to claims management and appropriate IS personnel.
3. Plans, implements, maintains and evaluates projects as related to pended encounters.
4. Responsible for planning the day to day tasks to be completed within the unit; trains and otherwise acts as a resource for the other encounter specialist in the department. Assists managerial staff with evaluation of error data.
5. Acts as a liaison with all internal and external resources, including third party interface programmers and technical advisors.
6. Performs immediate follow up on State imposed sanctions with documented refutation when appropriate.
7. Assists with special projects as needed, monitors and reports to the management staff on a regular basis regarding status of projects.
8. Responsible for reconciliation process with final accountability that all encounters have been submitted to the governing agency.
9. This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at all levels throughout the organization.
MINIMUM QUALIFICATIONS
Knowledge, skills and abilities as normally obtained through the completion of a bachelor's degree or equivalent experience preferred. Five years claims processing experience, preferably with AHCCCS experience.
Knowledge of AHCCCS encounter regulations and guidelines; strong written and verbal communication skills. Strong working knowledge of Microsoft Office software (Word, Excel, Access, PowerPoint). Good organizational/analytical skills; strong attention to details.
Ability to plan/direct projects and to analyze and trend system changes. Ability to communicate with AHCCCS technical and managerial personnel to identify system problems related to both procedures and programming. Ability to assist in the scheduling of daily tasks and to train new encounter specialists. Knowledge of data transfer protocols, ability to manage data files with mainframe system experience (non-Microsoft).
PREFERRED QUALIFICATIONS
Five years claims processing experience, preferably with AHCCCS preferred. Three years encounter experience with AHCCCS preferred. IDX experience, two years IDX or other claims systems experience preferred.
Additional related education and/or experience preferred. |
