Remote Utilization Review Manager Jobs in Canton, IL

Primary City/State:

Phoenix, Arizona

Department Name:

Charge Review-Rsrch

Work Shift:

Day

Job Category:

Research

Health care is constantly changing, and at Banner Health, we are at the front of that change. We are leading health care to make the experience the best it can be. We want to change the lives of those in our care - and the people who choose to take on this challenge. If changing health care for the better sounds like something you want to be part of, we want to hear from you.

As a Clinical Trial Billing Specialist, you will support the University of Arizona and Banner clinical trials across multiple specialties including Cardiac, Oncology, Neurology, and Orthopedics. You will be responsible for maintaining billing compliance by reading payer coverage analyses, dividing patient charges between sponsor-paid and patient-paid procedures, and interpreting contracts, budgets, and tracking systems to determine clinical trial coverage according to Medicare guidelines.

Join our collaborative team where you'll work from home while contributing to Banner's cutting-edge clinical trial treatments and ensuring accurate, compliant billing that directly impacts patient care. This is an excellent opportunity to be part of groundbreaking research while maintaining the highest standards of billing integrity across Banner's innovative clinical trial programs. The ideal candidate must be well-versed in Banner's billing systems, specifically Med Series 4 (MS4), RCx, nThrive, and NextGen (required).

Schedule: This role is primarily remote scheduled Monday-Friday, 8am to 4pm with occasional team meetings at Banner Alzheimer's Institute located in Phoenix.

Banner Alzheimer's Institute (BAI) was established in 2006 as Banner Health's first Center of Excellence. Banner Sun Health Research Institute (BSHRI) was founded in 1986. Our team is uniquely, passionately, and strategically committed to ending Alzheimer's disease and other neurodegenerative disorders without losing another generation, advancing oncology research to improve cancer prevention and treatment outcomes, and providing an unparalleled model of care for families facing these devastating diseases. Banner Research is committed to improving people's lives through comprehensive patient care and advances that capitalize on the best biomedical research. We intend to make a transformational difference in Alzheimer's disease, other neurodegenerative disorders, and oncology research and care.

POSITION SUMMARY

This position separates charges posted to patients' accounts from those paid for by a clinical trial sponsor and from those paid for by patients' insurance. Evaluates medical records, budgets, payer coverage analysis and clinical trial management systems to determine the appropriate separation for billing. Uses several Banner billing systems to create accounts and transfer charges. Assign clinical trial codes for Medicare compliance and accurate clinical trial billing.

CORE FUNCTIONS

1. Audits daily charges in Med Series 4 (MS4), NextGen, and nThrive. Matches, corrects, and transfers charges that are paid for by clinical trial sponsor. Responsible for working daily monitoring queries (SQRSL) that capture errors prior to billing as well as individual requests from the clinical trial coordinators, Central Billing Office, Ambulatory Billing Office, Patient Financial Services, and Research Finance.

2. Reviews patient records, dictated report(s), physician/provider notes for clinical trial information. Uses the Protocol, Payer Coverage Analysis, Budget, and Clinical Trial Management Systems for proper review.

3. Troubleshoots billing issues with private insurances and Medicare.Works with CBO, ABO, and PFS to ensure billing compliance and correcting claims.

4. Researches missing and incompatible records information supplied by medical staff, transcriptionists, suppliers, and others. Assures that all appropriate items, procedures, and services are recorded and appropriately billed.

5. Identifies opportunities for improvement in clinical trial compliance. Provides customer service to Clinical Trials Finance and Clinician staff. Maintains a current knowledge of procedural terminology requirements and provides team with updated information.

6. Works as a member of the clinical trial finance team to provide services and achieve goals. As assigned, manage billing issues, participate in compliance and education opportunities, and ensures Medicare compliance through entire billing process.

7. Works under regular supervision and with other charge review staff to maintain consistency in practice across Banner Research.

MINIMUM QUALIFICATIONS

High school diploma/GED or equivalent working knowledge.

Work effectively with Banner's billing systems: Med Series 4, NextGen, nThrive.

Requires a level of knowledge normally gained over two or more years of related work in the same type of clinical, medical office or acute care unit. Must be knowledgeable of medical terminology. Requires strong abilities in researching, reading, interpreting and communicating, as well as effective interpersonal skills, organizational skills and team working abilities.

PREFERRED QUALIFICATIONS

Current Procedural Terminology (CPT) coding experience in a similar setting and Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) credentials preferred for some assignments.

Additional related education and/or experience preferred.

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