We are so glad you are interested in joining Sutter Health!

Organization:

SHSO-Population Health Services-Valley

Position Overview:

Ensures that claims are processed timely, accurate, and that appropriate reimbursement is applied according to member's plan benefit. Conducts complex claims follow-up on processing or approval delays, taking corrective action(s) to finalize claims payment determination and/or referring claims to the appropriate clinical management staff for review so as to ensure appropriate reimbursement in the timeliest manner possible. Reviews, researches, and resolves rejected and/or denied claims, to ensure that all potential liabilities are paid in a timely and accurate fashion.

Job Description:

EDUCATION:
Equivalent experience will be accepted in lieu of the required degree or diploma.

• HS Diploma: High School Diploma or General Education Diploma (GED) or equivalent education/experience

TYPICAL EXPERIENCE:

• 2 years recent relevant experience.

SKILLS AND KNOWLEDGE:

• In-depth knowledge of various insurance documentation requirements, the patient accounting system, and various data entry codes to ensure proper service documentation and billing of the patient's account.
• Knowledge of insurance and governmental programs, regulations and billing processes (e.g., Medicare, MediCal, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, etc.), commercial third-party payers, managed care contracts and coordination of benefits.
• Knowledge of appeals and provider dispute processes and regulatory compliance.
• Deep familiarity with medical terminology and the medical record coding process.
• Organizational skills, thorough follow through and ability to work with minimal supervision.
• Ability to communicate ideas both verbally and in writing to interact with others using on-on-one contact and group discussions.
• Ability to independently set and organize own work priorities for self and for the assigned team, and successfully adapt to new priorities as part of a changing environment. Must be able to work concurrently on a variety of tasks/projects in an environment that demands a high degree of accuracy and productivity in cooperation with individuals having diverse personalities and work styles.

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Monday - Friday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

This position is work from home eligible.

Position Status:

Non-Exempt

Weekly Hours:

40

Employee Status:

Regular

Number of Openings:

1

Pay Range is $28.25 to $40.95 / hour. Colorado, Florida, Georgia, Ilinois Michigan, Nevada North Carolina, Oregon, Pennsylvania, Texas Pay Range is $25.42 to $36.86 / hour. Arizona, Arkansas, Idaho, Louisiana, Missouri, Montana, South Carolina, Tennessee, Utah Pay Range is $22.60 to $32.76 / hour.

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.