Quality Assurance Representative II – Managed Care

🔥 1 minute ago

⚜️ Louisiana, Texas, +2 more states – Remote

⚜️ Louisiana – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ☕ Washington – Remote

💵 $23 - $43 / hour

⏰ Full Time

🟢 Junior

🔧 QA Engineer (Quality Assurance)

🚫👨‍🎓 No degree required

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Sutter Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded Sutter Health was founded in 1996.

⚕️ Healthcare Insurance

🤝 Non-profit

💰 Grant on 2016-11

Healthcare Insurance • Non-profit

Sutter Health is a not-for-profit health system serving Northern California, offering a wide range of healthcare services. It provides comprehensive primary and specialty care, including mental health, oncology, orthopedics, women's health, and more. The organization supports both in-person and virtual visits, ensuring accessibility to its services. Sutter Health is also involved in medical research, education, and offers various health plans, including Sutter Health Plus. It emphasizes innovative, compassionate care and maintains a network of hospitals, medical groups, and other health providers across Northern California.

📋 Description

• Conducts performance and quality reviews/audits to promote completeness and accuracy • Ensure customer receives quality service and appropriate follow-through communication • 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 • Makes formal recommendations where appropriate • Assists in mentoring and collaborating with team members needing technical guidance • Serves as a resource to team or others

🎯 Requirements

• HS Diploma or General Education Diploma (GED) • 1 year of recent relevant experience. • 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 • 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

🏖️ Benefits

• Yes