Senior Health Claims Auditor

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 a few career-minded, growth-oriented individuals to make a real impact on our daily operations. Help Sagebrush Solutions LLC be a leader in the industry by acting as the Experienced Health Claims Auditor who builds client relationship; establishes project strategy; assembles project resources; develops project solutions; accomplishes project objectives; validates project solutions; manages client expectations; reduces costs and increases serviceability; updates job knowlege; accomplishes organization goals. Job responsibilites also includes supervising a team of auditors, including the participation in the audit work. Production must be maintained at 75-200 claims per day, depending on the complexity of the files this number may vary. Researching claim payment, history, provider status, internal guidelines, and recoveries to determine accuracy of overpayment. Client Liason. Support team in non-audit funtions: explaining findings to carrier, preparing report findings, researching refunds, data mining, providing feedback.

Qualifications

Required

4-year degree required. Broad experience in claims payment practices including COB processing, anethesia processng, multiple surgery guidelines, inpatient pricing and outpatient pricing. 3-5 years proven experience interpreting provider contracts. Ability to learn multiple claims platform. Self-starter, well organized, detail oriented and possess strong analytical skills. Excellent written and oral communicaitons skills. Ability to articulate reason for claim overpayment to inquiring healthcare providers. Ability to document and report findings. Working knowledge of Medicare applications rules, claim check rules and coordination of benefits guidelines. In-depth knowledge working with spreadsheets and other office applications. Prior experience in the consulting industry a plus.

Preferred

Uses understanding of the business to develop long term strategies to competitively position the company.

Presents information effectively and persuasively across communication settings.

Ability to develop and maintain strong rapport with clients.

Capable of facilitating discussion between individuals with differing perspectives.

Leverages relationships within the organization to achieve objectives.

Sets high expectations. Drives performance towards outstanding results.

Helps others handle organizational, technical, or procedural change.

Demonstrates ability to coach and develop people. Helps team members set and attain development goals.

Manages processes to monitor and to maximize performance.

Track record of maintaining quality standards for the team and implementing quality processes.

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.