Sutter Health Claims Team Member in Roseville, California

Description

Supports the delivery of all billing services by final/higher level auditing, correcting, and submitting 3rd party claims and patient statements. Ensures that billing services are timely, accurate, and appropriate reimbursement. Conducts all claims related follow up on payment delays, taking corrective action(s) to finalize account disposition and/or referring claims to the appropriate staff so as to ensure appropriate reimbursement in the most timely manner possible.

Supports the success of a high-performing shared services organization by helping to champion and drive the long-term Sutter Shared Services vision. Helps foster an environment in which continuous improvement in business processes and services is welcomed and recognized. Participates in programs and in using tools in support of building a high performance culture via the standard Sutter Shared Services responsibilities (e.g. performance measurement, people development, customer relationship management, etc.).

Qualifications

Education, Licensures, and Certifications:

• Associate’s degree in accounting/business field OR equivalent combination of education and experience required

• Certified Billing & Coding Specialist (CCS) desired

Experience:

• Demonstrates experience and a proven track record in Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims in a facility of significant size and complexity, hospital business operations, information systems, and patient accounting applications, as typically acquired in 0-2 years of acute hospital patient accounting positions

• Experience participating in Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims standards, processes, policies, procedures and service level agreements

• Experience in complex regional/ shared service environment with multiple/ matrix reporting relationships desired

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, and/or managed care contracts and coordination of benefits

• Familiarity with medical terminology and the medical record coding process

• In-depth knowledge of Revenue Cycle applications, including Hospital Patient Accounting

• In-depth knowledge/ awareness of all areas related to Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims and how they interrelate

• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections

• Familiarity with Payer-specific (Medicare, MediCal, Medicaid, Private) Claims management functions in acute and non-acute settings

• Knowledge of Patient Management information system applications, preferably EPIC

• Ability to execute strategy and communicate knowledge of business processes and enabling technologies, specifically in a Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims function

• Ability to comprehend and retain information that can be applied to work procedures to achieve appropriate service delivery

• Data entry skills (minimum 50-60 accurate keystrokes per minute)

• Requires strong accuracy, attentiveness to detail and time management skills

• Aptitude to conceptualize, plan, and implement stated goals and objectives

• Ability to independently set and organize own work priorities for self, 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

• Ability to communicate and work with patients, physicians, associates, Sutter Health leadership, multiple direct patient care providers and others in order to expedite the patient accounting process. Strong communication skills (verbal and written) in dealing with trainees, associates, and internal/external customers

• Ability to comply with Sutter Health policies and procedures

• Excellent ability to identify, prioritize, resolve and / or escalate complex problems promptly

• Excellent ability to establish, develop and manage customer relationships

• Ability to learn new applications/software systems effectively and efficiently

• Ability to communicate ideas both verbally and in writing to interact with others using on-on-one contact and group discussions

• Ability to recognize the appropriate style, level of detail, and message for the audience

• Ability to develop effective working relationships/ networks within and outside the organization

• Skills using spreadsheet, word processing, and basic statistical software applications, preferably Microsoft Suite

• Well-developed process design, implementation, and improvement skills

• High-level problem identification/ mitigation/ resolution and analytical skills

• Requires the ability to work with and maintain confidential information

Primary Location: California, Greater Sacramento Area, Roseville

Organization: Sutter Shared Services

Employee Status: Regular

Benefits: Yes

Position Status: Non-Exempt

Union: No

Job Shift: Day

Shift Hours: 8 Hour Shift

Days of the Week Scheduled: Monday-Friday

Weekend Requirements: Other

Schedule: Full Time

Hrs Per 2wk Pay Period: 80

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.