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.
POSITION SUMMARY 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.
CORE FUNCTIONS 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.
What might draw you to Banner Health? A great health care career, of course—and a great place to live, no matter what stage of life you’re in. With facilities across the West, there is a health care career for everyone, from big city living in the Phoenix area to friendly small towns in the mountains and plains. As one of the largest nonprofit health systems in the country, Banner Health offers both the stability that comes with success and the possibility of exploring new areas of the country. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages:
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 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.
Competitive compensation and comprehensive benefits offer you options to complement your unique needs.