Primary City/State:Phoenix, Arizona
Department Name:Provider Relations
Job Category:Administrative Services
The future is full of possibilities. At Banner Health, we're excited about what the future holds for health care. That's why we're changing the industry to make the experience the best it can be. If you're ready to change lives, we want to hear from you.
The Provider Relations Internal Team is on the front lines of research and resolution support for the provider network. We have a unique opportunity to work hand in hand with all departments throughout the organization.
Your pay and benefits are important components of your journey at Banner Health. Banner Health offers a variety of benefits 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.
This position is responsible for the training needs of Health Plan staff and contracted providers, including development of training materials, communications and activities. Provides training in all aspects of provider training, case management, medical management, compliance, and Claims adjudication to include professional, facility and dental claims. Responsible for regulatory guidance with AHCCCS training requirements, Commercial and Medicare rules and regulations Develops individualized and group training programs for staff and contracted providers based on regulations and contractual requirements, business needs, audit findings and claims adjustment team database errors.
1. Leads and manages training and provides educational guidance in behavioral health and long term care, Claims, Medical Management and Case Management staff as well as other areas of the organization. Develops, plans and implements individual and group training programs and materials based on business needs.
2. Interfaces with all departments within the health plan to ensure that the Claims, Medical Management training program supports all Customer Care, Medical Management, Network development, Grievance & Appeals, Case Management, Disease Management, Utilization Management and other care management programs including provider training programs (Arizona State Department/Division of Licensure to Home Care Training providers and other community service agencies.
3. Maintains working knowledge of AHCCCS and/or ALTCS and Medicare rules and regulations, CPT, ICD-9, ICD-10 and HCPC codes and other various guidelines as they impact the health plan, claims adjudication or medical management.
4. Assists managerial staff in developing and maintaining specific work procedures, policies and procedures, and process improvement processes. Provides timely and consistent feedback to managerial and supervisory staff in reference to training staff as well as works with supervisory staff on the progress of trainee's goals during the training period. Acts as a resource for staff.
5. Analyzes and utilizes data to provide focused individualized and/or group training for areas identified as needing additional training. Analyzes data and prepares weekly training schedules/reports for training.
6. Develops “train the trainer” program and keeps the “trainers” supplied with updated training materials. Assists in the designing and developing of web-based training materials. Manages and monitors priorities of active learning requests.
7. Participates in all mandatory compliance and other training programs and seeks guidance for compliance-related concerns and adheres to all applicable laws, regulations and HP policies and procedures.
8. Works independently under general supervision and exercises independent judgment. Flexes training programs based on training needs of department. Communicates with and build strong relationships with all staff and departments. Presents in a variety of formal presentation settings: one-on-one, small and large groups, with peers, and bosses; is effective both inside and outside of the organization, on both cool data and hot and controversial topics; commands attention and can manage group process during the presentation and can change tactics midstream when something is not working. Establishes good working relationships with all levels of support staff, providers, administrative staff and all other internal and external customers.
HS School Diploma or Equivalent. Knowledge, skills and abilities as normally obtained through two years training experience in an insurance and/or healthcare environment and three years related experience with Case Management, Disease Management, Utilization Management or behavioral healthcare and long term care environment, Professional, Dental and institution claims types.
Strong working knowledge of Microsoft Office Software (Word, Excel, Visio and PowerPoint) and IDX. Good organizational and analytical skills, strong written and verbal communication skills. Ability to pay close attention to detail and proficiency in multiple learning disciplines.
Knowledge of medical terminology and coding (ICD-9, CPT-4) and guidelines for JCAHO, NCQA, HEDIS, CMS, and AHCCCS may be required.
Bachelors in Healthcare or related field or equivalent. Experience with Acuity, Cerecons and Idx preferred; Experience with AHCCCS or ALTCS preferred.
Additional related education and/or experience preferred.
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