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Voted 4 years in a row by employees as Banner Health’s Best Place to Work and Best Place to Receive Care. Find your path in health care. When you join Banner Staffing Services, you join a team that puts patients first. You’ll make an impact on one of the country’s leading health systems and help make our patients’ lives easier. Apply today.

Bring your passion for Behavioral Health to Banner Health! Banner Behavioral Health Hospital in Scottsdale, AZ was remodeled and expanded in 2017, providing new, state-of-the art units for our patients and staff! Banner Behavioral Health Hospital is a voluntary facility for adults and adolescents. We are dedicated to providing safe, confidential, and compassionate treatment with customized treatment plans to meet each patient's needs.

We are looking for a Clinical Information Analyst/Utilization Management professional with at least one year of experience to assist with PRN work. This position will be on-site with potential for hybrid work in the future. Must possess an Arizona Fingerprint Clearance Card at the time of hire.

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
1. Evaluates and intervenes concurrently and retrospectively for level of care, coverage issues, payor outliers, split billing, disallowed charges, patient inquires, denial and compliance issues.

2. 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.

3. Tracks, monitors and documents denial causes and resolutions with appropriate management staff.

4. Acts as a knowledge resource for billing staff members. Identifies educational needs regarding payor issues, functions as preceptor, and provides appropriate education.

5. Builds and continually updates a knowledge of Third Party Payor requirements for covered treatment protocols by diagnosis, approval requirements for procedures, and coverage norms.

6. 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.

7. Works independently under limited supervision. Makes independent judgments based on specialized knowledge. Holds Facility or Regional responsibility for audited and denied billing issues. Internal customers: Patient/family, medical staff, case managers, nursing, social workers, patient services/placement/finances/audit, emergency department, clinic and all other departments and ancillary/support services. External customers: Medical Directors/payors/reviewers, contracted review agencies, other facilities/services, physician’s offices.

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. Employees working in the Banner McKee Senior Behavioral Health Inpatient Unit must possess a Colorado Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment. Employees working in any Banner Staffing (BSS) Behavioral Health role in Arizona must possess a State of Arizona Department of Public Safety Level One 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.

EOE/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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