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Team Member, Claims

Job ID SSS-1916926 Date Posted 08/21/2019 Location Salt Lake City, Utah Schedule/Shift Full Time / Day
Position Overview:

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.



Qualifications:

Education:
Associate's Degree in Accounting or Business or the equivalent education/experience required
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 required
Experience participating in Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims standards, processes, policies, procedures and service level agreements is required
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



Organization: Sutter Shared Services
Employee Status: Regular
Employee Referral Bonus: No
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: None
Schedule: Full Time
Hrs Per 2wk Pay Period: 80

Sutter Health Affiliates are equal opportunity employers EOE/M/F/Disability/Veterans

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