Claims Team MemberJob ID CWP-2121819 Date Posted 11/22/2021 Location Utah Schedule/Shift Temporary/Contract/ Day
Thank you for your interest in temporary contract opportunities with RightSourcing at Sutter Health and wanting to assist our team that proudly cares for more than 3 million of our neighbors across Northern California.
The Claims Team Member supports the delivery of all billing services by final/higher level auditing correcting and submitting 3rd party claims and patient statements. Ensuring that billing services are timely accurate and appropriate reimbursement. Conducting 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.
Responsibilities include performing all billing and follow-up functions including the investigation of payment delays resulting from pended claims with the objective of receiving appropriate reimbursement based upon services delivered and ensuring that the claim is paid/settled in the most timely manner possible • Applies knowledge of specific payer billing/payment rules managed care contracts reimbursement schedules eligible provider information and other available data and resources in order to research payment variances make corrections and take appropriate corrective actions to ensure timely claim resolutions • Submits 3rd party claims and patient statements including the maintenance of bill holds and the correction of errors in an effort to provide timely accurate billing services • Edits technical (UB-04) claim forms within the patient accounting system and external Claims Scrubber using proper data element instructions for each payer applying principles of coordination of benefits and ensuring that correct diagnosis and procedure codes are utilized • Researches claim rejections making corrections taking corrective actions and/or referring claims to appropriate staff members for follow through to ensure timely claim resolutions • Conducts account follow up including the investigation of payment delays resulting from pending claims with the objective of appropriately maximizing reimbursement based upon services delivered and ensuring claims are paid and settled in the most timely manner • Evaluates accounts resubmits claims and performs refunds adjustments write-offs and/or balance reversals if charges were improperly billed or if payments were incorrect • Responds to customer service tier 3 patient and 3rd party payer inquiries (telephone fax mail and web-based patient portal) complaints or issues regarding patient billing and collections either responding directly or referring the problem to an appropriate resource for resolution • In initial year participates in cross-training and job enlargement opportunities for Major job responsibilities. Works with direct supervisor to identify minor set of responsibilities to develop and perform in support of peaks valleys and cycles across the Shared Services Organization and individual career growth opportunities. Performs both Major and Minor responsibilities after initial year Continuous Improvement • Supports the implementation of programs policies initiatives and tools specific to the Shared Services Organizational process owned by Claims Lead across the Shared Services Organization. Participates in all others as appropriate • Contributes ideas and actions towards the continuous improvement of Claims Team related processes within area of influence Performance Management • Ensures delivery of business results by meeting or exceeding all individual operating metrics • Plans and organizes work so Individual Operating Metrics and Service Level Agreement objectives are realized • Recognizes and communicates potential issues to his/her team leader as appropriate
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 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 patients 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 Skills
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 School Diploma is required.
**Health insurance background, possible billing background. Background of explanation of benefits.
**This person will need to research credit balance lists given out to them to determine if an actual refund is due or we need to appeal if the insurance company is asking for money back.
**Person needs to pay attention to detail, so we do not refund money that does not need to be sent back. Also, needs to have experience with excel spreadsheets, and able to do basic math equations.
Employee Status: Temporary
Employee Referral Bonus: Yes
Position Status: Non-Exempt
Job Shift: Day
Shift Hours:8 Hour Shift
Days of the Week Scheduled:Monday-Friday
Weekend Requirements: None
Hrs Per 2wk Pay Period:80
Sutter Health Affiliates are equal opportunity employers EOE/M/F/Disability/VeteransApply Apply Later
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