Clinical Information Review Analyst

**Primary City/State:**Scottsdale, Arizona**Department Name:**Banner Staffing Services-AZ**Work Shift:**Day**Job Category:**Revenue CycleA rewarding career that fits your life.

Banner Staffing Services offers a world of opportunities to make an impact on one of the country’s leading health systems.

If you’re looking to leverage your abilities – you belong at Banner Staffing Services.Banner Staffing Services (BSS) offers Registry/Per Diem opportunities within Banner Health.

Registry/Per Diem positions are utilized as needed within our facilities.

These positions offer flexibility in scheduling and are great way to start your career with Banner Health.

As a BSS team member, you are eligible to apply (at any time) as an internal applicant to any regular opportunities within Banner Health.**As a valued and respected Banner Health team member, you will enjoy:**+ Competitive wages+ Paid orientation+ Flexible Schedules (select positions)+ Fewer Shifts Cancelled+ Weekly pay+ 403(b) Pre-tax retirement+ Employee Assistance Program+ Employee wellness program+ Discount Entertainment tickets+ Restaurant/Shopping discounts+ Auto Purchase Plan**Registry/Per Diem positions do not have guaranteed hours and no medical benefits package is offered** .

Registry/Per Diem positions require a minimum of 4 shifts a month commitment.

Completion of post-offer Occupational Health physical assessment, drug screen and background check (includes; employment, criminal and education) is required.**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.Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards.

Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.NOTE: The core functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties.

Specific tasks or responsibilities will be documented as outlined by the incumbent’s immediate manager.**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 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.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.Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability.