PFS Quality Analyst

Department Name:

Acute Billing & Follow Up-Corp

Work Shift:

Day

Job Category:

Revenue Cycle

Estimated Pay Range:

$24.32 - $36.48 / hour, based on location, education, & experience.

In accordance with State Pay Transparency Rules.

A rewarding career that fits your life. Those who have joined the Banner mission come from all walks of life, united by the common goal: Make health care easier, so life can be better. If changing health care for the better sounds like something you want to be part of, apply today.

Revenue Integrity has become a leading national focus to gain greater visibility for sound financial outcomes/practices, compliance and optimal reimbursement with focus across all continuums of patient care. Revenue Integrity in an integral part of the Revenue Cycle and covers all essentials related to it. We have teams comprised of Charge Capture, Pre-bill, Post-bill and

Monitoring (Auditing). RI also utilizes technology to enhance achievement along with an added focus where necessary that may include high dollar accounts, denials, improved A/R days and cash flow while collaborating with many areas such as Billing, Coding, CDM Services Expected reimbursement.

As the PFS Quality Assurance Specialist, you will perform analysis and audits of registration functions that support Patient Financial Services and ensure compliance with billing requirements.

Monday - Friday 8:00 AM - 4:30 PM

This can be a remote position if you live in the following state(s) only:

AL, AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, LA, MD, MI, MN, MO, MS, NC, ND, NE, NH, NY, NM, NV, OH, OK, OR PA, SC, TN, TX, UT, VA, WA, WI, WV, WY

Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. 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.

POSITION SUMMARY
This position assists with the overall quality, monitoring, analysis, reporting and audit management as necessary by contractual and regulatory requirements for Banner payors. This position also identifies and refers system issues to Production Control and Reimbursement Services to prevent disruption in workflow of the entire PFS department. Facilitates credit balances and underpayments on patient accounts. Collects, verifies, analyzes and summarizes data; identifies trends and communicates results to management. Serves as a resource to provide leadership with the data, trends, analyses, and information needed to help minimize loss of revenue. Assists with compliance reporting to insurance carriers and other third parties as required.

CORE FUNCTIONS
1. Analyze patient accounts to ensure consistent reimbursement for services rendered with contracts. As needed, provide recommendation to managed care for payor contract changes including phrasing, process, and missing documentation.

2. As assigned, make corrections to inaccurate accounts by processing patient and insurance refunds, transfers, adjustments, credit card refunds and overpayment letters from insurance carriers in an accurate and timely manner. Coordinates with other staff members, hospital and physician office staff as necessary to ensure accurate processing.

3. Identify system processing issues and provide correction recommendations to Production Control. Once corrected, assist with complex testing to ensure system is working correctly, thereby preventing costly workflow disruption to PFS department .

4. Uses multiple systems and/or programs to provide statistical data and prepare issues list(s) to accurately communicate with payers. May attend Payer meetings as scheduled.

5. Build strong working relationships with other departments, hospital departments and external customers. Identifies and analyzes trends in overpayment/underpayment issues, reimbursements, and production control and communicates with internal and external customers as appropriate to educate and correct issues. Prepare and present reports to various groups including auditors, various levels of management, payers and vendors.

6. As assigned, reconcile and balance payments, work with insurance remits, facility contracts, provider representatives, and spreadsheets to ensure maximum reimbursement.

7. As assigned, respond to incoming calls and make outbound calls as required to resolve credit balance issues. Pr