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As a Senior Claims Analyst you are responsible for conducting analysis, creating reports and performing financial reconciliations. Experience and proficient working knowledge of Microsoft Excel pivot tables and functions including but not limited to VLOOKUP, Macros, generating graphs and various financial calculations are needed. Ability to independently conduct data reconciliations and audits is strongly preferred and experience with financial reporting and insurance claims ( Malpractice and Worker's Compensation, not Health Insurance claims ) reporting is desirable.
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.
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 is responsible for the overall quality, monitoring, analysis and reporting of claims data including organization and effective presentation of information. Collects, verifies, analyzes and summarizes data; identifies trends, monitors loss experience and communicates results to team members, Business Health management and executive leadership. Serves as a key resource to provide leadership with the data, trends, analyses, and information needed to help minimize loss experience and improve employee and/or patient safety. Responsible for compliance reporting to insurance carriers and other third parties as required. Works closely with the Risk Management Information System (RMIS) System Administrator to provide secondary support to end users for problem resolution, training, system application and special functions/reporting.
CORE FUNCTIONS 1. Compiles, analyzes, organizes and interprets claim data for presentation to, and use by, Banner Health Home Office and MO executive management, including Board of Directors. Presents data results and analysis to Risk Management leadership and management as requested; provides recommendations for effective presentation of data and information to Banner Heath executive leadership.
2. Using appropriate software tools, develops reports for the overall quality and day-to-day monitoring of claims data. Identifies data integrity issues and resolution strategies, and implements appropriate corrections and improvements.
3. Through claim data analysis and both standard and ad-hoc report development, provides risk managers and executive management with analyses and trends to assist in identifying loss control opportunities and identification of potential areas of risk warranting corrective action. Provides recommendations and analyses in support of loss control programs/education. Generates and analyzes comparative data; establishes benchmarking and monitors results.
4. Manages multiple, concurrent projects, prioritizes tasks and adapts to frequent changes in departmental priorities. Recognizes necessary changes in priority of tasks and brings them to the attention of the CFO.
5. Identifies and pursues educational opportunities to expand and maintain a high degree of software application skills in the area of claims reporting systems, advanced spreadsheet functions, information databases, report-writing, and graphing.
6. Develops or assigns policies and procedures for data entry. Reviews and approves all completed policies prior to submission. Monitors the same for data integrity and identifies opportunities for education.
7. Maintains calendar and implements a plan to provide loss runs and other reports to insurers, insured's and management at appointed times. Communicates with outside consultants/vendors to develop specialized reports to satisfy compliance reporting requirements.
8. Assists RMIS System Administrator in training and testing of claims system upgrades and provides system implementation, support, training and development of other system applications.
9. Uses specialized knowledge to analyze information and solve business problems. Must possess initiative and good judgment and the ability to work independently with minimal supervision. Provides leadership with accurate and timely information necessary to effectively manage business health operations. Consults internally and cross-functionally with various layers of management and other key stakeholders.
Bachelor's degree and minimum three to five years experience or an equivalent combination of education and experience. Strong mathematical skills required. Statistical analysis training a plus.
Comprehensive working knowledge of computers, data manipulation, data analysis and trending. Exceptional attention to detail required. Demonstrated ability to transform data into information through effective compilation, analysis, organization, and presentation. Advanced working knowledge of Microsoft applications (Excel, PowerPoint, Word); advanced Excel graphing skill set required. Working knowledge of Microsoft Access a plus. Demonstrated advanced analytical skills required. Prior experience in claims analysis, reporting and presentation preferred. Working knowledge of medical terminology a plus. Excellent interpersonal, verbal and written communication, and presentation skills. Comfortable operating in a collaborative, shared leadership environment.
Technical aptitude, commitment and desire to maintain an advanced knowledge of computer application skills as well as learn new software applications and reporting tools; experience with claims reporting software, Cerner Power Chart functionality, and Business Objects preferred.
Additional related education and/or experience preferred.
Internal Number: R10532
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.
To improve the patient experience by providing health care providers; patients and their families; and others with information, education, networking opportunities, and related resources focused on best practices.