Claims Processor Ii, Sutter Health Plan

Organization:

Sutter Health Plan - Valley

Position Overview:

Performs comprehensive audits on accounts with associated corrections regarding billing, payment and adjustment errors; to perform these tasks within established time frames. 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.

Job Description:

EDUCATION:

• HS Diploma: High School Diploma or General Education Diploma (GED)

TYPICAL EXPERIENCE:

• 1 year 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.
• Ability to maintain composure during challenging interpersonal interactions.
• Proficient in using Microsoft Word, Excel, Visio and PowerPoint, and internet research.
• Ability to multi-task, including. ability to understand multiple products and multiple levels of benefits within each product is required.
• Able to effectively organize and prioritize tasks in order to complete assignments within the time allotted and maintain standard workflow.

PHYSICAL ACTIVITIES AND REQUIREMENTS:
See required physical demands, mental components, visual activities & working conditions at the following link: Job Requirements

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

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $26.14 to $37.91 / 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.