Quality Assurance Representative II, Managed Care

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

Organization:

SHSO-Population Health Services-Valley

Position Overview:

Conducts performance and quality reviews/audits to promote completeness and accuracy, and/or to ensure customer receives quality service and appropriate follow-through communication. Incumbent is assigned more complex transactions, requiring considerable research and analysis to complete. Proactively recognizes and identifies problems associated with complex issues related to customer needs; contract language, fee schedules, code editor, etc. Leverages experience and resources to reach a solution. Provides feedback to leadership and shares observations, trends and data with team, making formal recommendations where appropriate. Assists in mentoring and collaborating with team members needing technical guidance. Serves as a resource to team or others.

Job Description:

EDUCATION:

• HS Diploma or General Education Diploma (GED)

TYPICAL EXPERIENCE:

• 1 year of recent relevant experience.

SKILLS AND KNOWLEDGE:

• Medical billing and claims processing
• Various medical insurance types
• Healthcare operations
• Electronic health record systems
• Understand basic medical insurance terminology including CPT and ICD-10 codes
• Demonstrated effective verbal and written communication skills and ability work effectively with others
• Time management and organization skills
• Ability to formulate recommendations
• Demonstrates analytical and critical thinking skills with the ability to reconcile data differences
• Ability to multi-task and prioritize work to meet timelines
• Demonstrates follow-through on issues
• Demonstrates proficiency with using Outlook, Word, Excel, PowerPoint or similar programs
• Able to perform basic math calculations
• Ability to read and interpret diagrams and standard workflow/processes
• Demonstrates ability to mentor and teach others to support the development of peers

 

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Monday - Friday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

Position Status:

Non-Exempt

Weekly Hours:

40

Employee Status:

Regular

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

Pay Range is $29.96 to $43.45 / hour. New Jersey, Washington Pay Range is $29.96 to $43.45 / hour. Colorado, Florida, Georgia, Illinois, Michigan, Minnesota, Nevada, North Carolina, Ohio, Oregon, Pennsylvania, Texas, Virginia Pay Range is $26.97 to $39.11 / hour. Arizona, Arkansas, Idaho, Louisiana, Missouri, Montana, South Carolina, Tennessee, Utah Pay Range is $23.97 to $34.76 / hour.

The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.