Claims Auditor/Special (Non-Management)

About the Company Sagebrush Solutions LLC is a Statistical & Electronic Audit & Recovery Company serving organizations seeking to reduce the cost of heath care. We offer services to any organization with a need to reduce health care costs, including insurance companies, manage care organizations, large self-insured employers or benefits trusts. We work electronically with transactions data to identify and recover claim over payments, detect patterns of fraud or questionable billing practices and decrease claim expense through identification and recovery of third-party accuracy. We are seeking professionals looking to make a measurable contribution to a growing company. Members of the Sagebrush team have the opportunity to work in many capacities and must be self-motivated and enthusiastic. About the Opportunity We're looking for individuals who are interested in long-range career growth and have the strategic ability to plan for their professional futures. Sagebrush Solutions LLC offers significant opportunities for growth and career advancement. Employees are encouraged to take responsibility for their own careers. You'll be surrounded by people who are passionate about what they do. Help Sagebrush Solutions LLC be a leader in the Health Services industry by acting as the Claims Auditor/Specialist who work individually and/or with an engagementment team. responsible for identifying overpayments including but not limited to: duplicates, coordinaiton of benefits, clinical edits; network discounts, etc. ; performs research utilizing claims systems, policy contracts and provisions. performs research utilizing claims systems, policy contracts and provisions. performs research for internal call center issues. requires daily contact with claim payers/payees.

Qualifications

Strong familiarity with issues of compliance for state and federal regulations.

Conscientiously and methodically approaches work. Sees tasks through to completion.

Must have 3-5 years proven experience interpreting provider contracts. In-depth knowledge working with spreadsheets and other office applications.

Be able to articulate reason for claim overpayment to inquiring healthcare providers. Must have excellent written and oral communication skills. Ability to docuement and report findings.

Should have a broad experience in claim payment practices including COB processing, anesthesia processing, multiple surgery guidelines, inpatient and outpatient pricing. Ability of learn multiple claims platforms. Show a working knowledge of Medicare applications rules, claims check rules and coordination of benefits rules.

Competently analyzes and prioritizes information to make appropriate recommendations.

Uses multiple resources, quantitative, and qualitative research methodologies to capture and interpret information.

Must be a self-starter, well organized, detailed oriented and possess strong analytical skills.

BA or equivalent experience.

Benefits We offer unlimited potential for motivated professionals, great compensation, and full benefits including 401K, matching 401k, reimbursement for business expenses, dental insurance, medical insurance, disability benefits, life insurance, a vision-care plan, casual dress, flexible hours, paid company holidays, laptop computers, and free parking.

*Sagebrush Solutions LLC is an Equal Opportunity Employer. Sagebrush Solutions LLC is committed to workforce diversity. Qualified applicants will receive consideration without regard to age, race, color, religion, sex, sexual orientation, disability, or national origin. Applicants encouraged to confidentially self-identify when applying. Employment contingent upon successful completion of background investigation. Drug-free work environment. Relocation costs not covered by employer. Must be eligible to work in this country.